Management of Lower Extremity Ischaemia During Type A Dissection Repair

Type A aortic dissection can present with malperfusion syndrome. Lower limb ischaemia may resolve with repair of the dissection; however, the long duration of repair and/or persistent ischaemia may leave tissue at risk of necrosis with potential for substantial morbidity.

Here, the case of a 67 year old man who presented with a Type A aortic dissection with malperfusion of the lower extremities is described. The Vascular Surgery and Cardiac Surgery divisions were consulted simultaneously. A decision was made to perform bilateral superficial femoral artery cannulation with perfusion initially via the right axillary artery prior to sternotomy, then via the cardiopulmonary bypass circuit. At completion of the arch replacement, lower extremity inflow was reassessed with formal repair of the femoral arteries. Post-operatively, the patient had complete return of motor-sensory function, despite densely ischaemic symptoms at presentation several hours previously.

Cannulation of the superficial femoral arteries serves as a means to limit limb ischaemia intra-operatively and potentially improve outcomes in the setting of Type A aortic dissection with lower extremity malperfusion.