1 / 9

Lower Extremity Malperfusion Complicating Type A Dissection: A 10-year Single Center Experience

Lower Extremity Malperfusion Complicating Type A Dissection: A 10-year Single Center Experience. KM Charlton-Ouw MD 1 , K Sritharan BA 1 , SS Leake BS 1 , HK Sandhu MD 1 , CC Miller PhD 2 , A Azizzadeh MD 1 , HJ Safi MD 1 , AL Estrera MD 1. Department of Cardiothoracic and Vascular Surgery

alissa
Download Presentation

Lower Extremity Malperfusion Complicating Type A Dissection: A 10-year Single Center Experience

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Lower Extremity Malperfusion Complicating Type A Dissection: A 10-year Single Center Experience KM Charlton-Ouw MD1, K Sritharan BA1, SS Leake BS1, HK Sandhu MD1, CC Miller PhD2, A Azizzadeh MD1, HJ Safi MD1, AL Estrera MD1 Department of Cardiothoracic and Vascular Surgery The University of Texas Medical School at Houston Memorial Hermann Heart & Vascular Institute1 Department Biosciences, Texas Tech University Health Science Center2

  2. 59 year old man with chest pain and left leg pain.

  3. Acute Type A dissection with occlusion of left iliac artery.

  4. Objectives • Type A aortic dissection can result in malperfusion syndromes and are associated with poorer surgical outcomes and high morbidity and mortality. • Some advocate peripheral revascularization or endovascular procedures prior to proximal aortic repair. • We analyzed our practice of urgent proximal aortic repair, with additional revascularization in face of persistent ischemia, in proximal aortic dissections complicated by lower extremity ischemia.

  5. Methods

  6. Results • 142 of 296 cases (48.0%) complicated by malperfusion syndrome (MPS) • 28 (9.5%) patients had lower extremity MPS • 5 of 28 (6.5%) LE MPS patients needed peripheral bypass.

  7. Results • 52% of LE MPS patients suffered post-operative acute kidney injury and 44% needed hemodialysis. • Cardiac tamponade was associated with 21.4% of LE MPS patients. • GFR predictive of mortality • 14.2% overall in-hospital mortality (p=ns). • 14.8% mortality with any malperfusion (p=ns). • 13.6% mortality without malperfusion (p=ns). • Highest mortality in patients with mesenteric ischemia (67%). • Lowest mortality in patients with lower extremity malperfusion (10.7%)

  8. 30-day Mortality

  9. Conclusions • Lower extremity malperfusion in acute type A dissection is not predictive of mortality. • No justification for operative delay or percutaneous peripheral revascularization. • Majority of lower extremity malperfusion resolves after proximal aortic repair.

More Related