Medical management of acute type a aortic dissection in association with early open repair of acute limb ischemia may prevent aortic surgery

Abstract

SummaryBackground:Acute type A aortic dissection (AAAD) is a cardiovascular emergency with a high potential for death. Rapid surgical treatment is indicated to prevent fatal complications. Aggressive appropriate medical management starts at first suspicion and is essential to prevent exacerbation or rupture of the dissection. Despite improved surgical techniques, perioperative care and the development of specialized cardiovascular centers, mortality remains high. Organ ischemia is a catastrophic manifestation of aortic dissection, demanding acute surgical intervention in specialized cardiovascular centers.Case Report:We present the case of a 62-year-old man with isolated acute limb ischemia due to an acute type A aortic dissection treated in a regional general hospital, without a specialized cardiovascular service, with immediate open malperfusion repair and aggressive medical management. The patient did not undergo further surgical aortic repair, and after a 30-month follow-up he remains symptom free and in good clinical condition, suggesting that although aortic surgery remains the gold standard for treatment of acute Type A dissection, appropriate medical management and early malperfusion repair may offer an initial limb- or life-saving procedure.Conclusions:This staged approach gives clinicians more time to properly evaluate and transfer the patient to a specialized cardiovascular center, and in some cases may even offer a definite treatment.

The Effect of Beta-Blockers on Hemodynamic Parameters in Patient-Specific Blood Flow Simulations of Type-B Aortic Dissection: An Virtual Study

“…When comparing pressure values, using the results shown in Fig. 5, the pressure gradient along the whole aorta is significantly decreased; this behaviour indicates the successful effect of antihypertensive drugs [12,16,30] The WSS is principally essential in the study of AD because of its direct effect on the vessel wall [4,5], which cannot be measured invasively or experimentally. However, CFD can provide a great insight into this parameter and its resultant indices [4,5,29].…”

“…Pharmacological therapy has been used prior to surgical treatment or endovascular treatment [12,16]. Historically, in the early 1960s, according to the results of Wheat and associates experiments, it was found that two principal goals of pharmacological therapy are diminution of left ventricular ejection force (dp/dt) and reduction in BP [12,16].…”

“…Pharmacological therapy has been used prior to surgical treatment or endovascular treatment [12,16]. Historically, in the early 1960s, according to the results of Wheat and associates experiments, it was found that two principal goals of pharmacological therapy are diminution of left ventricular ejection force (dp/dt) and reduction in BP [12,16]. A standard group of drugs such as an -adrenergic and -adrenergic antagonist and Labetalol, in combination with beta-blockers (BBs) and sodium nitroprusside, are prescribed for routine medical therapy of type-B AD [12].…”

Aortic Dissection: An Easily Missed Diagnosis when Pain Doesn’t Hold the Stage

“…It should be noted that ischemic events affecting other territories (such as lower limbs) may be the dominant clinical feature of AD [20]. Hence, the main symptom at presentation of AD may be not thoracic pain but ischemia of one or multiple organs, which may eventually lead to treatment directed to the affected territory.…”

A Case of Aortic Dissection Presenting with Atypical Symptoms and Diagnosed with Transthoracic Echocardiography

“…The mortality rate for untreated patients with AD after symptoms start is about 1% per hour. As a result, early diagnosis is required for proceeding with the most appropriate medical or surgical treatment options [1]. In one study, patients with AD had been misdiagnosed in 16% of cases presenting to the ER and AD was not even included in the initial differential diagnoses [2].…”