title: [Ischemia of the lower limbs as a symptom of acute dissection of the ascending aorta].
abstract: A 27-year-old man, two 54-year old men and a 64-year-old woman presented with aspecific symptoms: acute pain and tingling in the shoulders plus paraplegia; exertional dyspnoea and tingling in both feet for the past week; increasing shortness of breath and cold, pale legs and feet for the past week; acute retrosternal pain, incontinence and paraparesis. The cause was dissection of the ascending aorta (type A). Following the operation, the legs were amputated because of ischaemia. The 27-year-old man and one of the 54-year-old men died; the other two patients made a satisfactory recovery. Acute type-A aortic dissection is a life-threatening disease that must be recognised early because it is an absolute indication for emergency surgery. The initial manifestation of type-A dissection may be very aspecific. Post-operative lower limb ischaemia, as the first symptom of this disease, is rare and usually disappears after surgery for type-A dissection. In some cases, however, ischaemia persists and alters the post-operative course dramatically.
authors.affiliation: St. Antonius Ziekenhuis, afd. Cardiothoracale Chirurgie, Koekoekslaan 1, 3435 CM Nieuwegein. erwin.tan@tiscali.nl
authors.forename: M E
authors.initials: ME
authors.lastname: Tan
authors.forename: W J
authors.initials: WJ
authors.lastname: Morshuis
authors.forename: K M
authors.initials: KM
authors.lastname: Dossche
authors.forename: M A
authors.initials: MA
authors.lastname: Schepens
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000175:diagnosis* / Q000601:surgery; D001014:Aortic Aneurysm / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology* / Q000601:surgery; D007866:Leg / Q000098:blood supply* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010264:Paraplegia / Q000209:etiology; D011183:Postoperative Complications