Comprehensive treatment of acute Stanford type A aortic dissection with limb malperfusion
10.3760/cma.j.cn112434-20220113-00014
- VernacularTitle:急性Stanford A型主动脉夹层合并下肢灌注不良的综合治疗
- Author:
Shibo SONG
1
;
Lin LU
;
Juxiang WANG
;
Hua PENG
;
Hui ZHUANG
;
Xijie WU
Author Information
1. 厦门大学附属心血管病医院心血管外科，厦门 361000
- Keywords:
Aortic dissection;
Limb malperfusion;
Comprehensive treatment
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2023;39(1):17-20
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore different strategies of central repair first or malperfusion first to treat type A aortic dissection complicated with limb malperfusion.Methods:From January 2020 to December 2021, 302 patients were diagnosed with acute type A aortic dissection, and 17 consecutive patients were diagnosed as type A acute aortic dissection complicated with limb malperfusion and underwent Sun’s procedure. There were 16 males and 1 female with an average of(52.6±4.2)years. Surgical strategies were as follows: immediate central repair-Sun’s procedure in 14 patients, endovascular stenting followed by central repair in 3 patients, endovascular stenting after central repair in 1 patient.Results:The incidence rate of limb malperfusion of acute Stanford A aortic dissection was 5.6%(17/302). Average extracorporeal circulation time was(271.8±38.9)min, average aortic cross-clamp time was (186.3±31.8)min, and the average circulatory arrest time was (48.75±11.3)min. Early mortality rate was 17.6%(3/17). Two patients were left hospital voluntarily because of cerebral infarction. One patient underwent leg incision osteofascial compartment syndrome and discharged unevently. Five patients underwent continuous renal replacement therapy and hemoperfusion. Follow-up results showed that patients with serious limb malperfusion have symptoms of nerve dysfunction including amyosthenia and sensory disturbance, but recovered gradually with rehabilitation.Conclusion:Sun’s procedure is safe and feasible for type A acute aortic dissection complicated with mild limb malperfusion. For serious limb malperfusion, endovascular stent followed by Sun’s procedure is a good choice with CRRT and hemoperfusion.
