The “TEVAR-First” Approach to DeBakey I Aortic Dissection With Mesenteric Malperfusion

Acute DeBakey type 1 aortic dissection presenting with mesenteric malperfusion is a lethal variant of all dissection-related malperfusion syndromes with reported mortality rates of 38% to 75%. Conventional surgical treatment involves proximal aortic replacement to restore true lumen perfusion, followed by mesenteric revascularization if malperfusion persists. In an attempt to improve the dismal outcomes associated with this malperfusion syndrome, we have instituted a [thoracic endovascular aortic repair] “TEVAR-First” approach in hemodynamically stable patients, which allows for earlier true lumen expansion and resolution of the malperfusion syndrome.