Clinical analysis of acute type-A aortic dissection with lower limb malperfusion_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 CUI Cong , ZHANG Li , GAO Xia , ZHANG Xianghui , XIAO Changbo , LU Wei , WU Gang , WANG Pingfan

Henan Province Chest Hospital, Zhengzhou, 450003, P.R.China;

Corresponding author：

CUI Cong, Email: conghuicui@163.com

Keywords：

Aortic dissection; Lower limb malperfusion; Surgical treatment

DOI：

10.7507/1007-4848.201709059

Video：

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Objective To explore the treatment experience of acute type-A aortic dissection with lower limb malperfusion. Methods From December 2012 to December 2016, 39 patients were diagnosed as acute type-A aortic dissection complicated with lower limb malperfusion and underwent operation.There were 27 males and 12 females with an average age of 51.4±12.4 years. Results Early mortality rate was 17.9%(7/39). 32 patients of postoperative survival. The follow-up rate was 93.8%(30/32), 3 months to 3 years after the operation, the results is satisfactory. The over lower limb malperfusion recovery rate of follow-up patients was 96.7%(29/30). Conclusion Positive operation for acute type-A aortic dissection with lower limb malperfusion is safe, feasible and effective.Concomitant or secondary bypass procedures are also possible to restore distal perfusion when necessary.Comprehensive evaluation of patient’s status is strongly recommended for optimal surgical decision making.

1.	De León Ayala IA, Chen YF. Acute aortic dissection: an update. Kaohsiung J Med Sci, 2012, 28(6): 299-305.
2.	Trimarchi S, Nienaber CA, Rampoldi V, et al. Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience. J Thorac Cardiovasc Surg, 2005, 129(1): 112-122.
3.	Geirsson A, Szeto WY, Pochettino A, et al. Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations. Eur J Cardiothorac Surg, 2007, 32(2): 255-262.
4.	Gargiulo M, Bianchini Massoni C, Gallitto E, et al. Lower limb malperfusion in type B aortic dissection: a systematic review. Ann Cardiothorac Surg, 2014, 3(4): 351-367.
5.	White RA, Miller DC, Criado FJ, et al. Report on the results of thoracic endovascular aortic repair for acute, complicated, type B aortic dissection at 30 days and 1 year from a multidisciplinary subcommittee of the Society for Vascular Surgery Outcomes Committee. J Vasc Surg, 2011, 53(4): 1082-1090.
6.	Gurin D, Bulmer JW, Derby R. Dissecting aneurysm of the aorta: diagnosis and operative relief of acute arterial obstruction due to this cause. NY State J Med, 1935, 35: 1200-1202.
7.	Santini F, Montalbano G, Casali G, et al. Clinical presentation is the main predictor of in-hospital death for patients with acute type A aortic dissection admitted for surgical treatment: a 25 years experience. Int J Cardiol, 2007, 115(3): 305-311.
8.	Augoustides JG, Geirsson A, Szeto WY, et al. Observational study of mortality risk stratification by ischemic presentation in patients with acute type A aortic dissection: the Penn classification. Nat Clin Pract Cardiovasc Med, 2009, 6(2): 140-146.
9.	Immer FF, Grobéty V, Lauten A, et al. Does malperfusion syndrome affect early and mid-term outcome in patients suffering from acute type A aortic dissection? Interact Cardiovasc Thorac Surg, 2006, 5(2): 187-190.
10.	Augoustides JG, Geirsson A, Szeto WY, et al. Observational study of mortality risk stratification by ischemic presentation in patients with acute type A aortic dissection: the Penn classification. Nat Clin Pract Cardiovasc Med, 2009, 6(2): 140-146.
11.	Sandridge L, Kern JA. Acute descending aortic dissections: management of visceral, spinal cord, and extremity malperfusion. Semin Thorac Cardiovasc Surg, 2005, 17(3): 256-261.
12.	汪忠镐. 主动脉夹层的治疗策略及手术要点. 临床误诊误治, 2012, 25(11): 1-5.
13.	Williams DM, Lee DY, Hamilton BH, et al. The dissected aorta: part III. Anatomy and radiologic diagnosis of branch-vessel compromise. Radiology, 1997, 203(1): 37-44.
14.	Sfyroeras GS, Rubio V, Pagan P, et al. Endovascular management of malperfusion in acute type B aortic dissections. J Endovasc Ther, 2011, 18(1): 78-86.
15.	曹芳芳, 冯雪, 张海涛, 等. 连续性血液净化治疗对Ⅰ型主动脉夹层术后横纹肌溶解伴急性肾衰竭患者的治疗效果观察. 中国血液净化, 2013, 12(1): 8-11.

1. De León Ayala IA, Chen YF. Acute aortic dissection: an update. Kaohsiung J Med Sci, 2012, 28(6): 299-305.
2. Trimarchi S, Nienaber CA, Rampoldi V, et al. Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience. J Thorac Cardiovasc Surg, 2005, 129(1): 112-122.
3. Geirsson A, Szeto WY, Pochettino A, et al. Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations. Eur J Cardiothorac Surg, 2007, 32(2): 255-262.
4. Gargiulo M, Bianchini Massoni C, Gallitto E, et al. Lower limb malperfusion in type B aortic dissection: a systematic review. Ann Cardiothorac Surg, 2014, 3(4): 351-367.
5. White RA, Miller DC, Criado FJ, et al. Report on the results of thoracic endovascular aortic repair for acute, complicated, type B aortic dissection at 30 days and 1 year from a multidisciplinary subcommittee of the Society for Vascular Surgery Outcomes Committee. J Vasc Surg, 2011, 53(4): 1082-1090.
6. Gurin D, Bulmer JW, Derby R. Dissecting aneurysm of the aorta: diagnosis and operative relief of acute arterial obstruction due to this cause. NY State J Med, 1935, 35: 1200-1202.
7. Santini F, Montalbano G, Casali G, et al. Clinical presentation is the main predictor of in-hospital death for patients with acute type A aortic dissection admitted for surgical treatment: a 25 years experience. Int J Cardiol, 2007, 115(3): 305-311.
8. Augoustides JG, Geirsson A, Szeto WY, et al. Observational study of mortality risk stratification by ischemic presentation in patients with acute type A aortic dissection: the Penn classification. Nat Clin Pract Cardiovasc Med, 2009, 6(2): 140-146.
9. Immer FF, Grobéty V, Lauten A, et al. Does malperfusion syndrome affect early and mid-term outcome in patients suffering from acute type A aortic dissection? Interact Cardiovasc Thorac Surg, 2006, 5(2): 187-190.
10. Augoustides JG, Geirsson A, Szeto WY, et al. Observational study of mortality risk stratification by ischemic presentation in patients with acute type A aortic dissection: the Penn classification. Nat Clin Pract Cardiovasc Med, 2009, 6(2): 140-146.
11. Sandridge L, Kern JA. Acute descending aortic dissections: management of visceral, spinal cord, and extremity malperfusion. Semin Thorac Cardiovasc Surg, 2005, 17(3): 256-261.
12. 汪忠镐. 主动脉夹层的治疗策略及手术要点. 临床误诊误治, 2012, 25(11): 1-5.
13. Williams DM, Lee DY, Hamilton BH, et al. The dissected aorta: part III. Anatomy and radiologic diagnosis of branch-vessel compromise. Radiology, 1997, 203(1): 37-44.
14. Sfyroeras GS, Rubio V, Pagan P, et al. Endovascular management of malperfusion in acute type B aortic dissections. J Endovasc Ther, 2011, 18(1): 78-86.
15. 曹芳芳, 冯雪, 张海涛, 等. 连续性血液净化治疗对Ⅰ型主动脉夹层术后横纹肌溶解伴急性肾衰竭患者的治疗效果观察. 中国血液净化, 2013, 12(1): 8-11.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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