Ascending Aortic Repair and Simultaneous Femoro-Femoral Crossover Bypass for Acute DeBakey Type I Dissection with Leg Ischemia

Abstract

A 61-year-old man was admitted with acute Type A aortic dissection DeBakey Type I with clinical and radiographic signs of left iliac artery occlusion and leg ischemia. He underwent simultaneous ascending aortic repair and surgical femoro-femoral crossover bypass with immediate restoration of leg perfusion as assessed with peripheral near-infrared spectroscopy. The postoperative course was uneventful. Follow-up computed tomography demonstrated occlusion of the left external iliac artery and patent crossover bypass.

Type A acute aortic dissection complicated by lower limb ischemia: simultaneous ascending aortic replacement and femoro-femoral crossover bypass

“…A combined approach (aortic repair and peripheral reperfusion) could have some advantages: allows the reperfusion of the ischemic limb before deep hypothermic circulatory arrest reducing ischemia-reperfusion injury; optimizes surgical timing; determines a direct reperfusion that is unrelated to decompression of the false lumen, and thus is more reliable; and can improve postoperative morbidity and mortality. 2,3…”

Management of Lower Extremity Ischaemia During Type A Dissection Repair

“… 4 Alternatively, simultaneous ascending aortic repair with femoro-femoral crossover bypass has been recommended for patients with suspected static occlusion. 5 Interestingly, Hussain et al. 6 have recently described temporary axillofemoral bypass for reperfusion of an ischaemic limb complicating Type A dissection.…”