Temporary femoro-femoral external shunt for lower-extremity malperfusion in acute type A aortic dissection

Acute limb ischemia is a severe complication of acute type A aortic dissection (ATAAD). The optimal management strategy remains debated and is dependent on the clinical context. Herein, we report the case of a 58-year-old man with ATAAD complicated by right lower limb malperfusion. During the aortic root replacement, regional oxygen saturation (rSO2) of the lower extremities was monitored using near-infrared spectroscopy, which demonstrated an early decline in right limb rSO2. To achieve prompt reperfusion, a femoro-femoral external shunt from the left to the right common femoral artery was established, serving as a bridge for definitive femoro-femoral bypass. The postoperative course was uneventful, without any evidence of reperfusion syndrome or neurological deficits. Thus, in certain cases, an external shunt may provide an effective bridging strategy for limb ischemia, and a decrease in rSO2 may serve as an early indicator for immediate reperfusion.