Management for lower limb malperfusion in acute type a aortic dissection patients

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Thoracic Surgery

Background:

• Acute type A aortic dissection (ATAAD) with lower limb malperfusion (LLM) presents a significant surgical challenge.
• Effective management strategies for ATAAD with LLM are crucial for improving patient survival and limb salvage.

Purpose of the Study:

• To evaluate the efficacy and safety of aortic repair combined with extra-anatomic bypass grafting for ATAAD patients with LLM.
• To assess the short-term and long-term outcomes, including mortality and complication rates, of this combined surgical approach.

Main Methods:

• A retrospective study of 61 patients diagnosed with ATAAD and LLM.
• All patients underwent urgent aortic repair (Total-arch or Hemi-arch replacement).
• Patients with persistent LLM received extra-anatomic bypass grafting (femorofemoral, aortofemoral, or combined).

Main Results:

• 62.3% of patients achieved satisfactory lower limb reperfusion after aortic repair alone.
• The combined approach resulted in a 9.8% hospital mortality rate and 87.5% 5-year survival rate.
• CTA confirmed 100% patency of extra-anatomic bypasses at a mean follow-up of 4.9 years.

Conclusions:

• Aortic repair combined with extra-anatomic bypass grafting is a safe and effective treatment for ATAAD with LLM.
• This one-stage surgical strategy improves limb perfusion and long-term survival in affected patients.
• The procedure demonstrates excellent patency rates for bypass grafts, supporting its clinical utility.