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Real-Time Assessment of Spinal Cord Microperfusion in a Porcine Model of Ischemia/Reperfusion
Published on: December 10, 2020
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Management strategy for lower extremity malperfusion due to acute aortic dissection
Anastasia Plotkin1, Diana Vares-Lum2, Gregory A Magee1
1Division of Vascular Surgery and Endovascular Therapy, Keck Medical Center of USC, Los Angeles, Calif.
Journal of Vascular Surgery
|May 3, 2021
Summary
Aortic dissection with lower extremity malperfusion (LEM) is often resolved by prompt aortic repair. Prioritizing aortic intervention over limb-first approaches reduces reoperation rates for this critical condition.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Aortic Disease Management
Background:
- Aortic dissection can lead to severe limb ischemia.
- Lower extremity malperfusion (LEM) is a critical complication of aortic dissection.
- Effective management strategies for LEM are crucial.
Purpose of the Study:
- To describe the management and outcomes of patients with aortic dissection and LEM.
- To compare the effectiveness of aortic repair first versus limb-first interventions.
Main Methods:
- A single-center database query for patients with aortic dissection and LEM (2011-2019).
- Primary endpoint: resolution of LEM post-aortic repair.
- Secondary endpoints: amputation, mortality, intervention time, complications.
Main Results:
- 5.5% of aortic dissection patients presented with LEM (n=42).
- Aortic repair before limb intervention (86%) had a lower early delayed failure rate (8%) compared to limb-first (50%).
- Overall amputation rate was 2%, and in-hospital mortality was 7%.
Conclusions:
- Primary aortic dissection intervention effectively resolves LEM in most cases.
- Urgent thoracic endovascular aortic repair (TEVAR) for type B and open repair for type A are emphasized.
- Limb-first interventions are associated with higher early delayed failure rates.
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