title: Delayed visceral and spinal cord malperfusion after axillo-bifemoral bypass for complicated acute type B aortic dissection.
abstract: We describe a successfully treated case of acute type B aortic dissection complicated with lower extremity, visceral, and spinal cord malperfusion. To restore perfusion to both lower extremities, we performed an emergency right axillo-bifemoral bypass. Furthermore, we performed total arch replacement, including primary entry closure, because of delayed visceral organ ischemia. Unexpectedly, delayed paraplegia occurred after hospital discharge; however, the patient recovered without any neurologic sequelae after early introduction of hyperbaric oxygen therapy. Because another episode of organ malperfusion in the long term cannot be anticipated, and even though the previous organ malperfusion episode was treated successfully, close observation is mandatory for detecting clinical manifestations in combination with the availability of imaging modalities.
authors.affiliation: Department of Cardiovascular Surgery, Numata Neurosurgery Heart-Disease Hospital, Numata, Gunma, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Morishita
authors.affiliation: Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's, Medical University, Tokyo, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Tomioka
authors.affiliation: Department of Surgery, Tokyo Rosai Hospital, Tokyo, Japan.
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Katahira
authors.affiliation: Department of Anesthesiology, Minami Machida Hospital, Machida, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hoshino
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Niigata University School of Medicine, Niigata, Niigata, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Hanzawa
keywords: acute type B aortic dissection; paraplegia; visceral malperfusion