Management strategy of acute aortic dissection of type A with lower limb ischemia

Objective To explore management strategy of acute aortic dissection of type A with lower limb ischemia.

Methods A retrospective analysis was performed in 318 patients with acute type A aortic dissection, including 34 patients with lower limb malperfusion(29 cases of unilateral lower limb ischemia and 5 cases of bilateral lower limb ischemia). The time from onset to operation was (5.2±1.3) h. A total of 18 cases of ischemic lower limb blood supply were restored by cardiopulmonary bypass (CPB) with 8 to 10 mm artificial blood vessel sewed from femoral artery and right axillary artery intubation. The healthy side femoral artery was intubated in 16 cases. A deep vein catheterization tube was inserted into the distal end of the affected femoral artery, and the lateral branch of the femoral artery cannula was connected to the proximal end of the deep vein catheterization tube to restore the blood supply to the remote end of the ischemic limb.

Results Of the 34 patients, 2 died, of which 1 died due to intestinal ischemic necrosis and the other died result from postoperative osteofascial compartment syndrome. There were 17 patients who underwent continuous renal replacement therapy (CRRT) due to acute renal failure, 1 patient who underwent colon and gallbladder necrosis after surgery underwent colon and gallbladder resection, no patient with rethoracotomy for hemostasis, and 3 patients who underwent retracheal intubation due to respiratory failure. During the follow-up of (27.2±3.5) months, 6 cases of femoral artery artificial vessel occlusion occurred.

Conclusion Type A aortic dissection with lower extremity ischemia has high mortality and more postoperative complications. Comprehensive preoperative evaluation, reasonable operation plan and active operation are the key to successful treatment.