Ileofemoral malperfusion complicating type a dissection: revascularization prevents renal failure.
We report four cases of lower extremity malperfusion complicating acute type A dissection. Two patients were treated with acute type A dissection repair, followed by axillobifemoral bypass grafting when malperfusion persisted after aortic replacement and required dialysis. Two patients were managed with lower extremity revascularization procedures before acute type A dissection repair and had preserved renal function. Lower extremity revascularization before cardiopulmonary bypass minimizes ischemia and allows for controlled limb reperfusion under hypothermic conditions compared with delayed normothermic reperfusion when performed after acute type A dissection repair. This strategy may increase limb function salvage and decrease the incidence of dialysis after acute type A dissection repair in patients presenting with lower extremity malperfusion.
Division of Cardiothoracic, Emory University, Atlanta, Georgia 30305-3404, USA. smlong3@yahoo.com
Stewart M
SM
Long
Deepak
D
Nair
Pegge M
PM
Halandras
Karthi
K
Kasirajan
Ross
R
Milner
Edward P
EP
Chen
D000328:Adult; D000784:Aortic Dissection / Q000150:complications* / Q000601:surgery; D001014:Aortic Aneurysm / Q000150:complications* / Q000601:surgery; D002315:Cardiopulmonary Bypass; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000517:prevention & control*