A Modified Procedure Using Branched
Graft as Inflow for Leg Revascularization in a Case of Acute
Type A Aortic Dissection Complicated with Leg Ischemia |
(Division of Cardiovascular Surgery, Narita Red
Cross Hospital, Narita, Japan and Department of Cardiovascular
Surgery, Funabashi Municipal Medical Center*, Funabashi, Japan)
Shigeyasu Takeuchi* |
Hisanori Fujita |
Nobuyuki Nakajima |
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A 32-year-old man with severe back
pain and cold, pulseless bilateral lower extremities was admitted.
Enhanced CT scan revealed acute type A aortic dissection and
the true lumen was severely compressed or occluded at the level
of the abdominal aorta. Emergency simultaneous graft replacement
of the ascending aorta and aortic arch was performed under deep
hypothermic circulatory arrest, antegrade selective cerebral
perfusion in addition to the elephant trunk technique. Although
distal anastomosis was constructed only to the true lumen, leg
ischemia persisted. Therefore, a new modified procedure applying
a branched graft used for antegrade systemic perfusion as inflow
and conventional axillo-bifemoral bypass graft was anastomosed
to restore adequate circulation to the lower extremities. In
the treatment of acute type A aortic dissection complicated with
leg ischemia, the modified technique we employed is a simple
and feasible method for leg revascularization in cases in which
malperfusion to the leg persists in spite of complete of aortic
repair.
Jpn. J. Cardiovasc. Surg. 33: 213-215 (2004) |
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