Lower limb malperfusion in type B aortic dissection: a systematic review.

Area of Science:

• Vascular Surgery
• Cardiovascular Medicine
• Aortic Diseases

Background:

• Lower limb malperfusion (LLM) syndrome complicates up to 40% of type B aortic dissections (TBAD).
• LLM is associated with increased 30-day mortality in TBAD patients.
• Understanding LLM in TBAD is crucial for improving patient outcomes.

Purpose of the Study:

• To systematically review clinical and procedural data of patients with LLM secondary to TBAD.
• To analyze the presentation, associated conditions, and treatment outcomes for LLM in TBAD.
• To provide insights into the management of this critical complication.

Main Methods:

• Systematic literature search of the PubMed database (January 2000 - June 2014).
• Inclusion of English-language publications reporting demographic and clinical data on LLM secondary to TBAD.
• Analysis of 29 papers involving 138 patients.

Main Results:

• LLM predominantly occurred in acute TBAD (97%) and presented as acute limb ischemia (87%).
• Bilateral presentation occurred in 56% of cases; LLM was the sole detected malperfusion in 52%.
• Associated renal (53%) and visceral (31-34%) malperfusion were common; endovascular treatment had lower mortality (8%) but high morbidity (46%) compared to surgery (14% mortality, 31% morbidity).

Conclusions:

• LLM in TBAD typically manifests acutely with limb ischemia, often bilaterally.
• Renal and visceral malperfusion frequently coexist with LLM, though LLM can be the only apparent malperfusion.
• Both surgical and endovascular treatments carry significant risks, highlighting the complexity of managing LLM in TBAD.