Type A Aortic Dissection Complicated by Renal and Lower Extremity Malperfusion

Objective: This study was conducted to evaluate pre- and intraoperative risk factors for 30-day mortality in patients with acute type A aortic dissection (ATAAD). Methods: Three hundred thirteen patients with ATAAD who underwent emergency surgery (264 men and 49 women; mean age, 48±10 years) were enrolled in our study. Preoperative and operative risk factors for death were presented. Multivariable analysis was performed to identify the influence of varying factors on 30-day mortality. Results: Overall, 32 patients (10.2%) died within 30 days. Compared with the surviving group, the deceased patients were more likely to have tachycardia, elevated serum potassium levels, moderate to severe pericardial effusion, suprasternal branch involvement, myocardial ischemia, and lower-extremity ischemia. Regarding factors related to surgery, the duration of surgery and cardiopulmonary bypass and concomitant procedures of coronary artery bypass graft（CABG） were greater in patients who died. In multivariate analysis, independent risk factors were longer duration of surgery (odds ratio [OR]: 4.5, p=0.001) and cardiopulmonary bypass (OR: 5.3, p=0.001), moderate to severe pericardial effusion (OR: 3.3, p=0.017), suprasternal branch involvement (OR: 4.9，p=0.002), and lower-extremity ischemia (OR: 7.6, p＜0.001). Conclusions: Lower-extremity ischemia and suprasternal branch involvement have the poorest outcomes. Moderate to severe pericardial effusion could influence the outcome. Shorter duration of surgery is associated with better outcomes. Key Words: acute type A aortic dissection, surgery, mortality, risk factors

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Type a Aortic Dissection Presenting with Acute Lower Extremity Vascular Insufficiency in the Absence of Chest Pain

Open Journal of Cardiovascular Surgery ◽

10.4137/ojcs.s8042 ◽

2012 ◽

Vol 5 ◽

pp. OJCS.S8042

Author(s):

Thomas J. Earl ◽

Athena Poppas

Keyword(s):

Chest Pain ◽

Aortic Dissection ◽

Lower Extremity ◽

Type A ◽

Type A Aortic Dissection ◽

Non Invasive ◽

Left Lower Extremity ◽

Vascular Insufficiency ◽

History Of ◽

Aortic Dissections

We report a case of a 53 year-old man with a history of hypertension presenting with acute left lower extremity parasthesias and pulselessness initially presumed to be secondary to arterial thrombosis or embolism. Work-up included a transthoracic echocardiogram which revealed an aortic dissection at the level of the aortic root extending to the visualized portions of the descending aorta. Type A aortic dissections are relatively rare, with the vast majority of patients presenting with chest pain. Timely diagnosis of Type A aortic dissections are critical as to facilitate rapid surgical repair. To our knowledge, this is the first report of a painless Type A aortic dissection presenting with isolated lower extremity vascular insufficiency and demonstrates the potential role of transthoracic echocardiography as a rapid, non-invasive bedside modality in visualizing Type A aortic dissections.

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One-stage surgery for type A aortic dissection and iliac artery aneurysm rupture

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320974866 ◽

2020 ◽

pp. 021849232097486

Author(s):

Eijiro Yamashita ◽

Taiji Watanabe ◽

Keisuk Shuntoh ◽

Kazunari Okawa ◽

Akiyuki Takahashi

Keyword(s):

Aortic Dissection ◽

Lower Extremity ◽

Iliac Artery ◽

Left Kidney ◽

Artery Aneurysm ◽

Limb Ischemia ◽

Type A ◽

Aneurysm Rupture ◽

Iliac Artery Aneurysm ◽

Type A Aortic Dissection

We present a patient with Stanford type A aortic dissection with malperfusion of the left kidney and lower extremity, and rupture of a common iliac artery aneurysm. After establishing lower extremity reperfusion using a percutaneous femorofemoral shunt in the emergency room, simultaneous open aortic arch repair and open abdominal aorta repair were performed. Our approach allowed concomitant repair of proximal dissection, limb ischemia, and iliac artery aneurysm rupture, all of which are critical predictors of mortality.

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