Objective To explore the treatment experience of acute type-A aortic dissection with lower limb malperfusion.Methods From December 2012 to December 2016,479 cases of acute type A aortic dissection were treated surgically,including 39 patients with lower limb ischemia,including 27 males and 12 females,with mean age of(5 1.4 ± 12.4) years.All patients were treated with deep hypothermic circulatory arrest and were treated with single pump,double-tube and double-injected limbs.According to the patient's lower limb ischemia time,symptoms and signs,limb ischemia was assessed.If necessary,femoral artery-femoral arterial bypass was performed.For patients undergoing femoral arterial-femoral prosthetic bypass during the same period,postoperative follow-up monitoring,if necessary,secondary femoral-femoral arterial vascular bypass or osteofascial decompression.Results Early mortality rate was 17.9％ (7/39).32 cases of postoperative survival.The follow-up rate was 93.8％ (30/32),3 months to 3 years after the operation,the results were 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.

Objective To investigate the changes of plantar pressure distributions and risk of falling before and after the occurrence of neurogenic intermittent claudication (NIC) in patients with central lumbar spinal stenosis (LSS), so as to provide theoretical and data references for the application of plantar pressure analysis in judgment of walking abilities for LSS patients. Methods Twelve patients with LSS at the L4-5 segment were selected as the LSS group, while twelve healthy adults at the same age were selected as the control group. Footscansystem was used to measure plantar pressure of these subjects during walking. Contact area percentage of the total foot contact area (CA%), pressure-time integral (PTI), foot progression angle (FPA), contact time percentage of the stance time (CT%) and total stance time (CT) in both LSS group and control group were compared to evaluate changes of plantar pressures during walking．Results Before the occurrence of NIC, compared with the control group, the LSS group had lower CT% during the forefoot push-off phase (FFPOP) and higher CT% during the initial contact phase (ICP), the total CT and FPA also increased, and the PTI of the 1st-3rd metatarsals and the CA% of the 2nd and 3rd metatarsals were higher. After the NIC occurred, for LSS group, CT% during ICP and forefoot contact phase (FFCP) decreased, CT% during the foot flat phase (FFP) and FFPOP as well as total CT and FPA increased, the PTI and CA% increased in 1st-4th metatarsals. Moreover, the CA% also increased in toe zone, both the PTI and CA% decreased in heel zone. Conclusions In patients with central LSS during walking, the distribution of plantar pressure shifts forward, with abnormal phase of the stance time occurring. Such abnormality will be further aggravated by NIC, indicating a higher risk of falling.