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

doi:10.3969/j.issn.1006-7795.2015.03.008

Abstract

Abstract:

Objective To explore the effect of Sun's procedure for type A acute aortic dissection complicated with lower limb ischemia. Methods From July 2009 to January 2014, 27 consecutive patients were diagnosed as type A acute aortic dissection complicated with lower limb ischemia and underwent total arch replacement using a tetrafurcated graft with stented elephant trunk implantation(Sun's procedure). There were 23 males and 3 females with an average age of (48.1±7.9)years. Concomitant proximal procedures included: aortic valve repair plus ascending aorta replacement in 7 patients, ascending aorta replacement alone in 10 patients, Bentall procedure in 8 patients and modified David procedure in 1 patient. Other concomitant procedures were: CABG in 2 patients, ascending aortic-femoral arterial bypass in 5 patients and femoral-femoral arterial bypass in 2 patients. Results Average extracorporeal circulation time was(209±61)min, average aortic cross-clamp time was(119±38)min, and the average circulatory arrest time was(27±11)min. Early mortality rate was 14.8%(4/27)and the morbidity rate was 55.6%(15/27). Mean time of follow-up was(41±27)month with a follow-up rate of 87.0%(20/23). One patient died of cerebrovascular event. No aortic related death occurred. One patient received secondary femoral-femoral artery bypass one month after Sun's procedure and recovered well. The overall lower limb ischemia recovery rate of operation survivors was 90.9%(20/22). Conclusion Sun's procedure is safe, feasible and effective for type A acute aortic dissection complicated with lower limb ischemia. Concomitant or secondary bypass procedures are also possible to restore distal perfusion when necessary. Comprehensive evaluation of patient's status is strongly recommended for optimal surgical decision making.

Key words: aortic dissection, lower limb ischemia, Sun's procedure

CLC Number:

R654

Rong Tianhua, Liu Yongmin, Zhu Junming, Ma Weiguo, Zhang Wei, Wang Longfei, Zhao Honglei, Pan Xudong, Sun Lizhong. Management of acute type A aortic dissection complicated with lower limb ischemia[J]. Journal of Capital Medical University, 2015, 36(3): 376-381.

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URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2015.03.008

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2015/V36/I3/376

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