Management of lower limb ischemia during operative repair of acute type a aortic dissection by distal crossover grafts: a case series
Rev. bras. cir. cardiovasc
;
35(5): 607-613, Sept.-Oct. 2020. tab
Artículo
en Inglés
| LILACS, SES-SP
| ID: biblio-1137336
ABSTRACT
Abstract Objective:
To describe our experience of nine patients with extra-anatomical bypass for clinically ischemic distal limb during repair of acute Type A aortic dissection (ATAAD).Methods:
We retrospectively examined a series of nine patients who underwent surgery for ATAAD. We identified a subset of the patients who presented with concomitant radiographic and clinical signs of lower limb ischemia. All but one patient (axillobifemoral bypass) underwent femorofemoral crossover grafting by the cardiac surgeon during cooling.Results:
One hundred eighty-one cases of ATAAD underwent surgery during the study period with a mortality of 19.3%. Nine patients had persistent clinical evidence of lower limb ischemia (4.9%) and underwent extra-anatomical bypass during cooling. Two patients underwent additional fasciotomies. Mean delay from symptoms to surgery in these nine patients was 9.5 hours. Two patients had bilateral amputations despite revascularisation and, of note, had long delays in presentation for surgery (> 12 hours). There were no mortalities during these inpatient episodes. Outpatient radiographic follow-up at the first opportunity demonstrated 100% patency.Conclusion:
Our experience suggests that, during complicated aortic dissection, limb ischemia may have a devastating outcome including amputation when diagnosis and referral are delayed. Early diagnosis and surgery are crucial in preventing this potentially devastating complication.
Texto completo:
Disponible
Índice:
LILACS (Américas)
Asunto principal:
Enfermedades Vasculares Periféricas
/
Disección Aórtica
Tipo de estudio:
Estudio de etiología
/
Estudio observacional
/
Estudio de tamizaje
Límite:
Femenino
/
Humanos
Idioma:
Inglés
Revista:
Rev. bras. cir. cardiovasc
Año:
2020
Tipo del documento:
Artículo
Institución/País de afiliación:
Liverpool Heart and Chest Hospital/GB
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