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A Method of Treating Patients with Acute Type A Aortic Dissection and Lower Extremity Malperfusion
Author(s) -
Tsiouris Athanasios,
Paone Gaetano,
Kabbani Loay,
Lin Judith,
Shepard Alexander D.,
Morgan Jeffrey A.
Publication year - 2014
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.12376
Subject(s) - medicine , aortic dissection , axillary artery , cardiopulmonary bypass , ascending aorta , percutaneous , aortic arch , cardiology , limb ischemia , surgery , dissection (medical) , aorta , perfusion , stroke (engine) , descending aorta , ischemia , mechanical engineering , engineering
The management of an acute type A aortic dissection in the setting of peripheral vascular malperfusion is not well defined. Several institutions proceed with initial percutaneous intervention to restore end organ perfusion, followed by delayed operative repair of the type A dissection. This strategy is associated with high mortality rates from aortic rupture, myocardial infarction, and stroke. We describe a technique, where acute limb ischemia is concomitantly managed with the replacement of the ascending aorta/hemiarch or aortic arch. In addition to axillary artery cannulation, the ischemic lower extremity is perfused through a polytetrafluoroethylene (PTFE) graft, which is connected to the cardiopulmonary bypass (CPB) circuit. doi: 10.1111/jocs.12376 (J Card Surg 2014;29:526–528)