Usefulness of transesophageal echocardiography in the evaluation of celiac trunk and superior mesenteric artery involvement in acute aortic dissection.

Moral, Sergio; Avegliano, Gustavo; Cuéllar, Hug; Ballesteros, Esther; Rodríguez-Palomares, Jose; Teixidó, Gisela; Galian, Laura; Gutiérrez, Laura; Evangelista, Arturo

Mesenteric ischemia is a serious complication of acute aortic dissection (AAD) and its early diagnosis is vital for prognosis and appropriate treatment indication. Arteries affected by this complication are the celiac trunk (CTr) and superior mesenteric artery (SMA) and their evaluation is usually based on computed tomography angiography (CTA). Transesophageal echocardiography (TEE) is also a useful technique for diagnosing AAD and is essential in monitoring surgical or endovascular treatment when CTA is not available. However, the usefulness of TEE for evaluating CTr and SMA involvement and mesenteric ischemia mechanisms in AAD is not well established. Real-time information on mesenteric malperfusion is needed at the bedside, in primary care facilities and the operating room to achieve prompt diagnosis and better therapeutic management. This review aims to assess the role of TEE to diagnose CTr and SMA involvement in AAD, determine the mechanisms which can cause flow obstruction in patients with mesenteric ischemia and analyze possible implications in the treatment of this complication.