title: Medical management of acute type a aortic dissection in association with early open repair of acute limb ischemia may prevent aortic surgery.
abstract: BACKGROUND
  Acute type A aortic dissection (AAAD) is a cardiovascular emergency with a high potential for death. Rapid surgical treatment is indicated to prevent fatal complications. Aggressive appropriate medical management starts at first suspicion and is essential to prevent exacerbation or rupture of the dissection. Despite improved surgical techniques, perioperative care and the development of specialized cardiovascular centers, mortality remains high. Organ ischemia is a catastrophic manifestation of aortic dissection, demanding acute surgical intervention in specialized cardiovascular centers.
  
  
  METHODS
  We present the case of a 62-year-old man with isolated acute limb ischemia due to an acute type A aortic dissection treated in a regional general hospital, without a specialized cardiovascular service, with immediate open malperfusion repair and aggressive medical management. The patient did not undergo further surgical aortic repair, and after a 30-month follow-up he remains symptom free and in good clinical condition, suggesting that although aortic surgery remains the gold standard for treatment of acute Type A dissection, appropriate medical management and early malperfusion repair may offer an initial limb- or life-saving procedure.
  
  
  CONCLUSIONS
  This staged approach gives clinicians more time to properly evaluate and transfer the patient to a specialized cardiovascular center, and in some cases may even offer a definite treatment.
authors.affiliation: Vascular Surgery Department, University of Crete Medical School, Heraklion, Greece ; Department of Thoracic Surgery, Regional General Hospital of Chania, Greece.
authors.forename: Michalis N
authors.initials: MN
authors.lastname: Gionis
authors.forename: George
authors.initials: G
authors.lastname: Kaimasidis
authors.forename: Emmanouel
authors.initials: E
authors.lastname: Tavlas
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Kontopodis
authors.forename: Marina
authors.initials: M
authors.lastname: Plataki
authors.forename: Alexandros
authors.initials: A
authors.lastname: Kafetzakis
authors.forename: Christos V
authors.initials: CV
authors.lastname: Ioannou
keywords: aortic dissection; limb ischemia; medical treatment; minimally invasive management; revascularization