Management of lower limb ischemia during operative repair of acute type a aortic dissection by distal crossover grafts: a case series
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.
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