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Case Reports

Ileofemoral Malperfusion Complicating Type A Dissection: Revascularization Prevents Renal Failure

^a Division of Cardiothoracic, Emory University, Atlanta, Georgia
^b Division of Vascular Surgery, Emory University, Atlanta, Georgia

Accepted for publication July 6, 2007.

^_* Address correspondence to Dr Long, Emory University, Division of Cardiothoracic Surgery, 2880 Alpine Rd, Atlanta, GA 30305-3404 (Email: smlong3{at}yahoo.com).

We report four cases of lower extremity malperfusion complicating acute type A dissection. Two patients were treated with acute type A dissection repair, followed by axillobifemoral bypass grafting when malperfusion persisted after aortic replacement and required dialysis. Two patients were managed with lower extremity revascularization procedures before acute type A dissection repair and had preserved renal function. Lower extremity revascularization before cardiopulmonary bypass minimizes ischemia and allows for controlled limb reperfusion under hypothermic conditions compared with delayed normothermic reperfusion when performed after acute type A dissection repair. This strategy may increase limb function salvage and decrease the incidence of dialysis after acute type A dissection repair in patients presenting with lower extremity malperfusion.

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