title: Method of treating patients with acute type A aortic dissection and lower extremity malperfusion.
abstract: The management of an acute type A aortic dissection in the setting of peripheral vascular malperfusion is not well defined. Several institutions proceed with initial percutaneous intervention to restore end organ perfusion, followed by delayed operative repair of the type A dissection. This strategy is associated with high mortality rates from aortic rupture, myocardial infarction, and stroke. We describe a technique, where acute limb ischemia is concomitantly managed with the replacement of the ascending aorta/hemiarch or aortic arch. In addition to axillary artery cannulation, the ischemic lower extremity is perfused through a polytetrafluoroethylene (PTFE) graft, which is connected to the cardiopulmonary bypass (CPB) circuit.
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital Heart and Vascular Institute, Detroit, Michigan.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Tsiouris
authors.forename: Gaetano
authors.initials: G
authors.lastname: Paone
authors.forename: Loay
authors.initials: L
authors.lastname: Kabbani
authors.forename: Judith
authors.initials: J
authors.lastname: Lin
authors.forename: Alexander D
authors.initials: AD
authors.lastname: Shepard
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Morgan
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000601:surgery*; D001011:Aorta / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery*; D001366:Axillary Artery; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002315:Cardiopulmonary Bypass; D002404:Catheterization; D005260:Female; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D016896:Treatment Outcome
chemical_list: D011138:Polytetrafluoroethylene