Treating lower extremity malperfusion syndrome in acute type A aortic dissection with endovascular revascularization followed by delayed aortic repairCentral MessagePerspective
Objective: To assess the outcomes of emergency revascularization with endovascular fenestration/stenting followed by delayed open aortic repair in patients with acute type A aortic dissection with lower extremity (LE) malperfusion syndrome (MPS); that is, necrosis and dysfunction of the lower extrem...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-06-01
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| Series: | JTCVS Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S266627362200078X |
| _version_ | 1818214293317877760 |
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| author | Elizabeth L. Norton, MD, MS Felix Orelaru, MD Aroma Naeem, BA Xiaoting Wu, PhD Karen M. Kim, MD David M. Williams, MD Shinichi Fukuhara, MD Himanshu J. Patel, MD G. Michael Deeb, MD Bo Yang, MD, PhD |
| author_facet | Elizabeth L. Norton, MD, MS Felix Orelaru, MD Aroma Naeem, BA Xiaoting Wu, PhD Karen M. Kim, MD David M. Williams, MD Shinichi Fukuhara, MD Himanshu J. Patel, MD G. Michael Deeb, MD Bo Yang, MD, PhD |
| author_sort | Elizabeth L. Norton, MD, MS |
| collection | DOAJ |
| description | Objective: To assess the outcomes of emergency revascularization with endovascular fenestration/stenting followed by delayed open aortic repair in patients with acute type A aortic dissection with lower extremity (LE) malperfusion syndrome (MPS); that is, necrosis and dysfunction of the lower extremity. Methods: From 1996 to 2019, among 760 consecutive acute type A aortic dissection patients 512 patients had no malperfusion syndrome (Non-MPS), whereas 26 patients had LE-MPS with/without renal MPS and underwent endovascular fenestration/stenting, open aortic repair, or both. Patients with coronary, cerebral, mesenteric, and celiac MPS, or managed with thoracic endovascular aortic repair, were excluded (n = 222). All patients with LE-MPS underwent upfront endovascular fenestration/stenting except 1 patient (with signs of rupture) who initially underwent emergency open aortic repair. Results: Among the LE-MPS patients, 17 (65%) had LE pain, 15 (58%) had abnormal motor function with 8 (31%) having paralysis, 10 (38%) had LE pallor, 17 (65%) had LE paresthesia, and 20 (77%) had LE pulselessness. Of the 25 patients undergoing upfront endovascular fenestration/stenting, 16 went on to open aortic repair, 3 survived to discharge without aortic repair, and 6 died before aortic repair (3-aortic rupture and 3-organ failure). In-hospital mortality among all patients was significantly higher in the LE-MPS group (31% vs 6.3%; P = .0003). Among those undergoing open aortic repair, postoperative outcomes were similar between groups, including operative mortality (18% vs 6.5%; P = .10). LE-MPS was a significant risk factor for in-hospital mortality (odds ratio, 6.0 [1.9, 19]; P = .002). Conclusions: In acute type A aortic dissection, LE-MPS was associated with high in-hospital mortality. Emergency revascularization with endovascular fenestration/stenting followed by delayed open aortic repair may be a reasonable approach. : Video Abstract: |
| first_indexed | 2024-12-12T06:17:53Z |
| format | Article |
| id | doaj.art-d37c05758a134c20a9d76658e5cb3f7b |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-12-12T06:17:53Z |
| publishDate | 2022-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-d37c05758a134c20a9d76658e5cb3f7b2022-12-22T00:34:58ZengElsevierJTCVS Open2666-27362022-06-0110101110Treating lower extremity malperfusion syndrome in acute type A aortic dissection with endovascular revascularization followed by delayed aortic repairCentral MessagePerspectiveElizabeth L. Norton, MD, MS0Felix Orelaru, MD1Aroma Naeem, BA2Xiaoting Wu, PhD3Karen M. Kim, MD4David M. Williams, MD5Shinichi Fukuhara, MD6Himanshu J. Patel, MD7G. Michael Deeb, MD8Bo Yang, MD, PhD9Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, GaDepartment of General Surgery, St Joseph Mercy, Ann Arbor, MichDepartment of Cardiac Surgery, Michigan Medicine, Ann Arbor, MichDepartment of Cardiac Surgery, Michigan Medicine, Ann Arbor, MichDepartment of Cardiac Surgery, Michigan Medicine, Ann Arbor, MichDepartment of Radiology, Michigan Medicine, Ann Arbor, MichDepartment of Cardiac Surgery, Michigan Medicine, Ann Arbor, MichDepartment of Cardiac Surgery, Michigan Medicine, Ann Arbor, MichDepartment of Cardiac Surgery, Michigan Medicine, Ann Arbor, MichDepartment of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich; Address for reprints: Bo Yang, MD, PhD, Department of Cardiac Surgery, Michigan Medicine, 1500 E Medical Center Dr, 5155 Frankel Cardiovascular Center, Ann Arbor, MI 48109.Objective: To assess the outcomes of emergency revascularization with endovascular fenestration/stenting followed by delayed open aortic repair in patients with acute type A aortic dissection with lower extremity (LE) malperfusion syndrome (MPS); that is, necrosis and dysfunction of the lower extremity. Methods: From 1996 to 2019, among 760 consecutive acute type A aortic dissection patients 512 patients had no malperfusion syndrome (Non-MPS), whereas 26 patients had LE-MPS with/without renal MPS and underwent endovascular fenestration/stenting, open aortic repair, or both. Patients with coronary, cerebral, mesenteric, and celiac MPS, or managed with thoracic endovascular aortic repair, were excluded (n = 222). All patients with LE-MPS underwent upfront endovascular fenestration/stenting except 1 patient (with signs of rupture) who initially underwent emergency open aortic repair. Results: Among the LE-MPS patients, 17 (65%) had LE pain, 15 (58%) had abnormal motor function with 8 (31%) having paralysis, 10 (38%) had LE pallor, 17 (65%) had LE paresthesia, and 20 (77%) had LE pulselessness. Of the 25 patients undergoing upfront endovascular fenestration/stenting, 16 went on to open aortic repair, 3 survived to discharge without aortic repair, and 6 died before aortic repair (3-aortic rupture and 3-organ failure). In-hospital mortality among all patients was significantly higher in the LE-MPS group (31% vs 6.3%; P = .0003). Among those undergoing open aortic repair, postoperative outcomes were similar between groups, including operative mortality (18% vs 6.5%; P = .10). LE-MPS was a significant risk factor for in-hospital mortality (odds ratio, 6.0 [1.9, 19]; P = .002). Conclusions: In acute type A aortic dissection, LE-MPS was associated with high in-hospital mortality. Emergency revascularization with endovascular fenestration/stenting followed by delayed open aortic repair may be a reasonable approach. : Video Abstract: http://www.sciencedirect.com/science/article/pii/S266627362200078Xlower extremitymalperfusion syndromeaortic dissectionendovascularopen aortic repair |
| spellingShingle | Elizabeth L. Norton, MD, MS Felix Orelaru, MD Aroma Naeem, BA Xiaoting Wu, PhD Karen M. Kim, MD David M. Williams, MD Shinichi Fukuhara, MD Himanshu J. Patel, MD G. Michael Deeb, MD Bo Yang, MD, PhD Treating lower extremity malperfusion syndrome in acute type A aortic dissection with endovascular revascularization followed by delayed aortic repairCentral MessagePerspective JTCVS Open lower extremity malperfusion syndrome aortic dissection endovascular open aortic repair |
| title | Treating lower extremity malperfusion syndrome in acute type A aortic dissection with endovascular revascularization followed by delayed aortic repairCentral MessagePerspective |
| title_full | Treating lower extremity malperfusion syndrome in acute type A aortic dissection with endovascular revascularization followed by delayed aortic repairCentral MessagePerspective |
| title_fullStr | Treating lower extremity malperfusion syndrome in acute type A aortic dissection with endovascular revascularization followed by delayed aortic repairCentral MessagePerspective |
| title_full_unstemmed | Treating lower extremity malperfusion syndrome in acute type A aortic dissection with endovascular revascularization followed by delayed aortic repairCentral MessagePerspective |
| title_short | Treating lower extremity malperfusion syndrome in acute type A aortic dissection with endovascular revascularization followed by delayed aortic repairCentral MessagePerspective |
| title_sort | treating lower extremity malperfusion syndrome in acute type a aortic dissection with endovascular revascularization followed by delayed aortic repaircentral messageperspective |
| topic | lower extremity malperfusion syndrome aortic dissection endovascular open aortic repair |
| url | http://www.sciencedirect.com/science/article/pii/S266627362200078X |
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