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Management of lower limb ischemia during operative repair of acute type a aortic dissection by distal crossover grafts: a case series
Theologou, Thomas; Harky, Amer; Shaw, Matthew; Eltyeb, Hazim; Elbakbak, Walid; Snosi, Mostafa; Harrington, Deborah; Kuduvalli, Manoj; Oo, Aung; Field, Mark.
Afiliação
  • Theologou, Thomas; Liverpool Heart and Chest Hospital. Department of Cardiothoracic Surgery. Liverpool. GB
  • Harky, Amer; Liverpool Heart and Chest Hospital. Department of Cardiothoracic Surgery. Liverpool. GB
  • Shaw, Matthew; Liverpool Heart and Chest Hospital. Department of Cardiothoracic Surgery. Liverpool. GB
  • Eltyeb, Hazim; Liverpool Heart and Chest Hospital. Department of Cardiothoracic Surgery. Liverpool. GB
  • Elbakbak, Walid; Liverpool Heart and Chest Hospital. Department of Cardiothoracic Surgery. Liverpool. GB
  • Snosi, Mostafa; Liverpool Heart and Chest Hospital. Department of Cardiothoracic Surgery. Liverpool. GB
  • Harrington, Deborah; Liverpool Heart and Chest Hospital. Department of Cardiothoracic Surgery. Liverpool. GB
  • Kuduvalli, Manoj; Liverpool Heart and Chest Hospital. Department of Cardiothoracic Surgery. Liverpool. GB
  • Oo, Aung; Liverpool Heart and Chest Hospital. Department of Cardiothoracic Surgery. Liverpool. GB
  • Field, Mark; Liverpool Heart and Chest Hospital. Department of Cardiothoracic Surgery. Liverpool. GB
Rev. bras. cir. cardiovasc ; 35(5): 607-613, Sept.-Oct. 2020. tab
Artigo em Inglês | LILACS, Sec. Est. Saúde SP | ID: biblio-1137336
Biblioteca responsável: BR1.1
ABSTRACT
Abstract

Objective:

To describe our experience of nine patients with extra-anatomical bypass for clinically ischemic distal limb during repair of acute Type A aortic dissection (ATAAD).

Methods:

We retrospectively examined a series of nine patients who underwent surgery for ATAAD. We identified a subset of the patients who presented with concomitant radiographic and clinical signs of lower limb ischemia. All but one patient (axillobifemoral bypass) underwent femorofemoral crossover grafting by the cardiac surgeon during cooling.

Results:

One hundred eighty-one cases of ATAAD underwent surgery during the study period with a mortality of 19.3%. Nine patients had persistent clinical evidence of lower limb ischemia (4.9%) and underwent extra-anatomical bypass during cooling. Two patients underwent additional fasciotomies. Mean delay from symptoms to surgery in these nine patients was 9.5 hours. Two patients had bilateral amputations despite revascularisation and, of note, had long delays in presentation for surgery (> 12 hours). There were no mortalities during these inpatient episodes. Outpatient radiographic follow-up at the first opportunity demonstrated 100% patency.

Conclusion:

Our experience suggests that, during complicated aortic dissection, limb ischemia may have a devastating outcome including amputation when diagnosis and referral are delayed. Early diagnosis and surgery are crucial in preventing this potentially devastating complication.
Assuntos


Texto completo: Disponível Coleções: Bases de dados nacionais / Brasil Contexto em Saúde: ODS3 - Meta 3.4 Reduzir as mortes prematuras devido doenças não transmissíveis Problema de saúde: Doença Cardiovascular Base de dados: LILACS / Sec. Est. Saúde SP Assunto principal: Doenças Vasculares Periféricas / Dissecção Aórtica Tipo de estudo: Estudo de etiologia / Estudo observacional / Estudo de rastreamento Limite: Feminino / Humanos Idioma: Inglês Revista: Rev. bras. cir. cardiovasc Ano de publicação: 2020 Tipo de documento: Artigo Instituição/País de afiliação: Liverpool Heart and Chest Hospital/GB

Texto completo: Disponível Coleções: Bases de dados nacionais / Brasil Contexto em Saúde: ODS3 - Meta 3.4 Reduzir as mortes prematuras devido doenças não transmissíveis Problema de saúde: Doença Cardiovascular Base de dados: LILACS / Sec. Est. Saúde SP Assunto principal: Doenças Vasculares Periféricas / Dissecção Aórtica Tipo de estudo: Estudo de etiologia / Estudo observacional / Estudo de rastreamento Limite: Feminino / Humanos Idioma: Inglês Revista: Rev. bras. cir. cardiovasc Ano de publicação: 2020 Tipo de documento: Artigo Instituição/País de afiliação: Liverpool Heart and Chest Hospital/GB
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