Ileofemoral Malperfusion Complicating Type A Dissection: Revascularization Prevents Renal Failure

• Published in: The Annals of thoracic surgery Vol. 84; no. 6; pp. 2099 - 2101
• Main Authors: Long, Stewart M., MD, Nair, Deepak, MD, Halandras, Pegge M., MD, Kasirajan, Karthi, MD, Milner, Ross, MD, Chen, Edward P., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.12.2007; Elsevier Science
• Subjects: Adult; Aneurysm, Dissecting - complications; Aneurysm, Dissecting - surgery; Aortic Aneurysm - complications; Aortic Aneurysm - surgery; Biological and medical sciences; Cardiopulmonary Bypass; Cardiothoracic Surgery; Humans; Ischemia - surgery; Leg - blood supply; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Renal failure; Renal Insufficiency - prevention & control; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Surgery of the respiratory system; 26; Kidney disease; Dissecting aneurysm; Prevention; Urinary system disease; Treatment; Respiratory disease; Surgery; Renal failure; Complication; Thorax; Revascularization
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2007.07.011

We report four cases of lower extremity malperfusion complicating acute type A dissection. Two patients were treated with acute type A dissection repair, followed by axillobifemoral bypass grafting when malperfusion persisted after aortic replacement and required dialysis. Two patients were managed with lower extremity revascularization procedures before acute type A dissection repair and had preserved renal function. Lower extremity revascularization before cardiopulmonary bypass minimizes ischemia and allows for controlled limb reperfusion under hypothermic conditions compared with delayed normothermic reperfusion when performed after acute type A dissection repair. This strategy may increase limb function salvage and decrease the incidence of dialysis after acute type A dissection repair in patients presenting with lower extremity malperfusion.