A modified axillo-femoral perfusion for acute type a aortic dissection accompanied with lower limb malperfusion

被引:9
作者
Li, Qianzhen [1 ]
Chen, Liangwan [1 ]
Shen, Yue [1 ]
Li, Jiahui [1 ]
Dong, Yi [1 ]
机构
[1] Fujian Med Univ, Dept Cardiac Surg, Union Hosp, Fuzhou, Fujian, Peoples R China
关键词
Aortic dissection; Lower limb malperfusion; Aortic surgery; Axillo-femoral perfusion; BRANCHED STENT GRAFT; AXILLARY ARTERY; OPEN PLACEMENT; MANAGEMENT; ISCHEMIA; REPERFUSION; SURGERY; BYPASS; REPAIR; DELAY;
D O I
10.1186/s13019-020-1060-2
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Lower limb malperfusion accompanied with acute type A dissection (AAD) is reported to be an independent predictor for mortality. Timely treatment is required. However, staged approach to restore the perfusion of the ischemic leg before aortic repair has a continuously increase risk of aortic rupture. Aortic repair under isolated axillary artery perfusion also has the risk of prolonging leg ischemia. Here we introduce our experience in performing axillo-femoral perfusion, which is supposed to bring benefits for treating lower limb malperfuison. Methods Thirty patients who suffered AAD accompanied by lower limb ischemia enrolled in our study. All patients received aortic repair as soon as possible using the modified axillo-femoral perfusion approach. The cardiopulmonary bypass and cooling started with the right axillary artery perfusion. Then the femoral artery of the ischemic side was exposed and sewn to a graft connected with another inflow cannula. The rectal temperature was about 31 degrees C when the femoral perfusion started. The perfusion of the ischemic legs preoperative was estimated after the surgery by the clinical signs, the saturation of the distal-limb, and computed tomography scan. Results Twenty-eight patients got good perfusion of the lower body after the surgery. Two patients received femoral-femoral artery bypass immediately after surgery because of the thrombosis in the right common iliac artery, without further injury. No peripheral vessels damage occurred, and no compartment fasciotomy or amputation needed. One patient died for the sepsis and the subsequent multi organ failure 28 days postoperative. Conclusions The modified axllio-femoral perfusion could restore the lower limbs' perfusion simultaneously during the aortic surgery without neither delaying dissection repair nor prolonging the ischemic time. It is a simple, but safe and effective technique.
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页数:5
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共 25 条
  • [1] The cannulation strategy in surgery for acute type A dissection
    Abe, Tomonobu
    Usui, Akihiko
    [J]. GENERAL THORACIC AND CARDIOVASCULAR SURGERY, 2017, 65 (01) : 1 - 9
  • [2] Acute Aortic Dissection Clinician Update
    Braverman, Alan C.
    [J]. CIRCULATION, 2010, 122 (02) : 184 - 188
  • [3] VASCULAR COMPLICATIONS ASSOCIATED WITH SPONTANEOUS AORTIC DISSECTION
    CAMBRIA, RP
    BREWSTER, DC
    GERTLER, J
    MONCURE, AC
    GUSBERG, R
    TILSON, MD
    DARLING, RC
    HAMMOND, G
    MEGERMAN, J
    ABBOTT, WM
    [J]. JOURNAL OF VASCULAR SURGERY, 1988, 7 (02) : 199 - 209
  • [4] Management of limb ischemia in acute proximal aortic dissection
    Charlton-Ouw, Kristofer M.
    Sritharan, Kaji
    Leake, Samuel S.
    Sandhu, Harleen K.
    Miller, Charles C., III
    Azizzadeh, Ali
    Safi, Hazim J.
    Estrera, Anthony L.
    [J]. JOURNAL OF VASCULAR SURGERY, 2013, 57 (04) : 1023 - 1029
  • [5] Total arch repair for acute type A aortic dissection with open placement of a modified triple-branched stent graft and the arch open technique
    Chen, Liang-Wan
    Wu, Xi-Jie
    Dai, Xiao-Fu
    Lu, Lin
    Liao, Dong-Shan
    Li, Chao
    Li, Qian-Zhen
    [J]. JOURNAL OF CARDIOTHORACIC SURGERY, 2014, 9
  • [6] Total arch repair with open triple-branched stent graft placement for acute type A aortic dissection: Experience with 122 patients
    Chen, Liang-Wan
    Lu, Lin
    Dai, Xiao-Fu
    Wu, Xi-Jie
    Zhang, Gui-Can
    Yang, Guo-Feng
    Dong, Yi
    [J]. JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2014, 148 (02) : 521 - 528
  • [7] Extensive Primary Repair of the Thoracic Aorta in Acute Type A Aortic Dissection by Means of Ascending Aorta Replacement Combined With Open Placement of Triple-Branched Stent Graft Early Results
    Chen, Liang-Wan
    Dai, Xiao-Fu
    Lu, Lin
    Zhang, Gui-Can
    Cao, Hua
    [J]. CIRCULATION, 2010, 122 (14) : 1373 - 1378
  • [8] Total aortic arch reconstruction with open placement of triple-branched stent graft for acute type A dissection
    Chen, Liang-Wan
    Dai, Xiao-Fu
    Zhang, Gui-Can
    Lu, Lin
    [J]. JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2010, 139 (06) : 1654 - U329
  • [9] Surgical delay for acute type A dissection with malperfusion
    Deeb, GM
    Williams, DM
    Bolling, SF
    Quint, LE
    Monaghan, H
    Sievers, J
    Karavite, D
    Shea, M
    [J]. ANNALS OF THORACIC SURGERY, 1997, 64 (06) : 1669 - 1675
  • [10] Management of acute infrarenal aortic occlusion secondary to type A dissection
    Garrett, HE
    Wolf, BA
    [J]. ANNALS OF THORACIC SURGERY, 2006, 81 (04) : 1500 - 1502