[Acute aortic dissection and peripheral ischemia. Diagnostic and therapeutic problems. Remote control using nuclear...

This study concerns 7 cases of acute aortic dissection associated with visceral and/or lower limb ischemia. Only those cases are included which raised diagnostic and therapeutic problems. Patients were excluded who had purely angiographic involvement of an aortic branch and minor rapidly resolving ischemic syndromes. Five of the 7 patients presented type B (type III or distal) and 2 type A (type I or proximal) dissection. All patients received anti-hypertensor medical treatment. All but one had undergone surgery at least once at the acute stage. Five had been followed up and monitored by magnetic resonance imaging (MRI). One type A and 4 type B dissections were thus reviewed between the 15th month and the 9th year. Diagnostically, aortography was found to be inaccurate twice because of incomplete exploration of the thoracoabdominal aorta. Therapeutically, a case of intraoperative death occurred during replacement of the ascending aorta. Thus, out of the 6 patients who survived the acute stage, 4 are alive and asymptomatic, one has been lost sight of and the other died in year 5 after surgery for chronic dissecting aneurysm of the aortic arch. Among the 5 patients examined by MRI, 4 presented aortic ectasia, chronic dissecting aneurysm of the aortic arch and/or a descending aorta with a diameter between 45 and 65 mm. The patient with subnormal aortic diameter had his ascending aorta replaced (the follow-up period at this writing is only 27 months). Among 3 patients who were examined twice, one showed improvement after a year's interval, with a 5-mm increase in the caliber of the dissected aorta.(ABSTRACT TRUNCATED AT 250 WORDS)