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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2008 February;21(1):41-3
Perfusion via preceding axillofemoral artery bypass graft in repair of type A acute aortic dissection with leg ischemia
Takagi H., Kato T., Sekino S., Manabe H., Matsuno Y., Umemoto T.
Department of Cardiovascular Surgery Shizuoka Medical Center, Shizuoka, Japan
Leg ischemia in acute aortic dissection, caused by stenosis or occlusion of the aorta or the iliofemoral artery due to extension of the dissection, is a serious complication as well as myocardial, cerebrospinal, or visceral ischemia, because it may result in neurological deficits, compartment syndrome, necrosis, or myopathic-nephrotic-metabolic syndrome. The authors hereupon describe arterial perfusion for cardiopulmonary bypass via a side branch of a preceding axillofemoral artery bypass graft in repair of Stanford type A acute aortic dissection with unilateral leg ischemia, which has never found in the literature to our knowledge. A 65-year-old man was diagnosed as Stanford type A acute aortic dissection with right leg ischemia due to extension of the dissection. Right axillo-right femoral artery bypass with a prosthetic graft was subcutaneously placed before median sternotomy, and cardiopulmonary bypass was established with arterial perfusion via a side branch of the bypass graft. Replacement of the ascending aorta was successfully performed with retrograde cerebral perfusion and deep hypothermic circulatory arrest of the lower half of the body. The postoperative arterial pulsation of the right leg recovered completely without neurological deficits, compartment syndrome, necrosis, or myopathic-nephrotic-metabolic syndrome. Advantage of the novel approach for the entity is discussed.