Prevalence, Clinical Features and Outcomes of Patients with Acute Aortic Dissection and Concomitant Lower Extremity Malperfusion

Objective: The aim of this study was to describe the prevalence and clinical characteristics of patients presenting with lower limb malperfusion (LLM) following an aortic dissection, and the outcomes of the patients repair of the dissection as the initial operative procedure. Method: We performed a retrospective medical record review at our single center of patients who presented with an aortic dissection complicated by LLM from January 2019 to June 2023, and analyzed the incidence, clinical characteristics, prognosis and reintervention of these patients. Result: The incidence of patients with an aortic dissection complicated by LLM was 6.3% (39/617) with mortality rate of 23% (9/39). LLM cases were associated with malperfusion of other organs in 77% (30/39) of patients. All surgical patients underwent initial aortic central repair, with a mortality rate of 26% (8/30). Mortality rates were 31.8% (7/22) for type A dissections and 12.5% (1/8) for type B dissections. Immediate femoral-femoral bypass grafting was performed in 10% (3/30) of cases following aortic central repair, with the majority of patients experiencing significant improvement in LLM with aortic central repair alone. The postoperative readmission rate due to LLM was 6.7% (2/30). Conclusion: Aortic dissection with lower limb malperfusion (LLM) is associated with increased pre- and postoperative mortality, especially in Type A aortic dissections versus Type B. However, for survivors of initial central aortic repair surgery, the rates of amputation and readmission for LLM are low.