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- W2969652044 abstract "Acute type A aortic dissection (ATAD) presenting with acute limb ischemia (ALI) has been identified as a predictor of in-hospital mortality. This study examined the outcome of patients presenting with ATAD with ALI. A prospectively collected database was queried for all cases of ATAD repaired between 2002 and 2018 at a tertiary referral center. Patients with ALI were identified. Univariate comparisons between groups with and without lower extremity ALI were made. During this period, 378 patients underwent ATAD repair, of whom 62 patients (16.4%) presented with ALI. Thirty-five patients (9.2%) presented with isolated ALI, whereas 27 (7.1%) had concomitant malperfusion in at least one other organ system. Of the 62 patients presenting with ALI, 46 (74.2%) underwent proximal aortic repair alone, whereas 16 (25.8%) patients also underwent lower extremity vascular intervention. The ischemic limb was perfused during repair of the ATAD by a side perfusion cannula from the bypass circuit in 10 patients. There were six amputations (9.7%) performed in the ALI group, two of which had peripheral vascular repairs. Fasciotomies were performed on 18 patients; of these, 5 had concomitant peripheral vascular repairs. Of the 55 patients with ALI surviving past 24 hours, 34 (61%) had resolution of the lower limb ischemia with proximal repair only. The 30-day survival was decreased in patients who presented with any organ malperfusion (P = .012). In patients with isolated ALI, there was no significant difference in 30-day mortality (11.4%) compared with the group with no malperfusion (15.7%; P = .5). Sixteen patients underwent peripheral vascular procedures for limb ischemia, including 10 patients who underwent bypass procedures (7 femoral-femoral, 1 axillary-femoral-femoral, and 2 axillary-femoral), with 1 patient dying within 24 hours. All six patients with adequate follow-up imaging had asymptomatic occlusion of the bypass graft with recanalization of the occluded native arteries on computed tomography angiography. Proximal repair of ATAD resolves most associated ALI. Isolated ALI did not increase 30-day mortality. All patients with follow-up who underwent extra-anatomic bypass developed asymptomatic graft occlusion. This was attributed to competitive flow from the remodeled native arterial system." @default.
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- W2969652044 date "2019-09-01" @default.
- W2969652044 modified "2023-09-28" @default.
- W2969652044 title "Lower Limb Malperfusion in Acute Type A Dissection" @default.
- W2969652044 doi "https://doi.org/10.1016/j.jvs.2019.06.139" @default.
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