title: Acute Complex Type A Dissection associated with peripheral malperfusion syndrome treated with a staged approach guided by lactate levels.
abstract: Acute type A aortic dissection can be complicated by visceral malperfusion and is associated with a significant surgical morbidity and mortality. We describe a case of successful management of a complex acute type A dissection with mesenteric and lower limb ischemia treated with endovascular thoracic stenting and femoro-femoral crossover bypass grafting followed by aortic arch repair. To accomplish this, we applied a staged therapeutic approach using serial lactate measurements to assess the adequacy of peripheral perfusion and metabolic status prior to surgical repair of the proximal dissection.
authors.affiliation: Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, UK.
authors.forename: Amna
authors.initials: A
authors.lastname: Suliman
authors.forename: Michael
authors.initials: M
authors.lastname: Dialynas
authors.forename: Hutan
authors.initials: H
authors.lastname: Ashrafian
authors.forename: Colin
authors.initials: C
authors.lastname: Bicknell
authors.forename: Maziar
authors.initials: M
authors.lastname: Mireskandari
authors.forename: Mohamad
authors.initials: M
authors.lastname: Hamady
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
mesh_terms: D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D002985:Clinical Protocols; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology; D019344:Lactic Acid / Q000097:blood; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011859:Radiography; D015607:Stents; D013577:Syndrome; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D019344:Lactic Acid