Newly developed aortic dissection in the abdominal aorta after femoral arterial perfusion

Background. Aortic dissection after femoral arterial perfusion has been reported as a dreadful complication. Apart from such a drastic event, using intraoperative transesophageal echocardiography we detected aortic dissection confined to the abdominal aorta that was associated with visceral malperfusion. Methods. We examined 11 consecutive patients with aortic dissection in whom the abdominal aorta was intact, and surgeries were performed with femoral perfusion. The abdominal aorta and visceral branches were examined for new development of dissection or malperfusion by means of transesophageal echocardiography before, during, and after cardiopulmonary bypass. These echocardiographic findings were then related to the postoperative assessment and midterm results. Results. Aortic dissection was found in 3 of 11 cases (27.2%). Unusual progression of metabolic acidosis (base excess <= 10 mEq/L) occurred, possibly as a result of malperfusion of visceral arteries, in 2 of these 3 cases, whereas none of the 8 cases presented with such findings. The presence of dissection was later confirmed by postoperative computed tomography in all but I case. In the midterm follow-up period, aneurysm formation was found in the infrarenal aorta and iliac arteries in 2 of the 3 cases with new aortic dissection but not in any of the remaining 8 cases. Conclusions. New development of aortic dissection after femoral arterial perfusion was found in 27% of the cases in this series. Although these occurred without dramatic symptoms, this event may be related to unusual metabolic acidosis during cardiopulmonary bypass or to subsequent aneurysmal formation of the infrarenal aorta or iliac arteries, or both. (c) 2005 by The Society of Thoracic Surgeons.