Abstract
The incidence of lower extremity ischemia secondary to acute aortic dissection is relatively low, however, the presenting symptoms are variable in term of severity. We report here in two cases of such circumstances who were successively differently treated. Case one was a 60 years old male presented with severe left leg pain. Even after the initiation of cardiopulmonary bypass, the leg ischemia did not improve, therefore selective leg perfusion was additionally performed through direct left femoral artery cannulation. The surgery toward dissection was completed by mean of simultaneous graft replacement of ascending aorta and aortic arch. The leg ischemia after the aortic procedure however had persisted, femorofemoral bypass was created to relieve the mal-perfusion. Case two was a 37 years old male admitted with severe left leg pain associated with sensory-motor nerve dysfunction with muscle rigidity. In this particular patient, femorofemoral bypass was firstly reconstructed as the mean of leg salvage procedure. After we learned there was no serious reperfusion symptom manifested, we performed radical surgery toward the aorta. We believe that the decision making of surgical treatment for acute type A dissection complicated with the presence of lower extremity ischemia is based on the severeness of mal-perfusion.
Similar content being viewed by others
References
Cambria RP, Brewster DC, Gertler J, Moncure AC, Gusberg R, Tilson D, Darling RC, Hammond G, Megerman J, Abbott WM: Vascular complications associated with spontaneous aortic dissection. J Vasc Surg 7: 199–209, 1988
Fann JI, Sarris GE, Mitchell RS, Shumway NE, Stinson EB, Oyer PE, Miller DC: Treatment of patients with aortic dissection presenting with peripheral vascular complications. Ann Surg 212: 705–713, 1990
Spittell PC, Spittell JA Jr, Joyce JW, Tajik AJ, Edward WD, Schaff MV, Stanson AW: Clinical features and differential diagnosis of aortic dissection: Experience with 236 cases (1980 through 1990). Mayo Clin Proc 68: 642–651, 1993
20(Suppl): 1435–1437, 1991
20(Suppl): 1438–1440, 1991
20(Suppl): 1441–1443, 1991
20(Suppl): 1444–1447, 1991
A. 20(Suppl): 1447–1450, 1991
20(Suppl): 1450–1452, 1991
20(Suppl): 1453–1455, 1991
20(Suppl): 1456–1458, 1991
20(Suppl): 1458–1461, 1991
20(Suppl): 1461–1464, 991
44: 499–504, 1996
2. 4: 681–686, 1995
Haimovici, H: Muscular, renal, and metabolic complications of acute arterial occlusions: Myonephropathic-metabolic syndrome. Surgery 85: 461–468, 1979
Myonephropathic metabolic syndrome (mnms). 17(Suppl): 483–485, 1988
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Sunazawa, T., Takahara, Y. & Sudo, Y. Acute type a aortic dissection with leg ischemia. Jpn J Thorac Caridovasc Surg 46, 1004–1008 (1998). https://doi.org/10.1007/BF03217863
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03217863