دورية أكاديمية
Treating lower extremity malperfusion syndrome in acute type A aortic dissection with endovascular revascularization followed by delayed aortic repairCentral MessagePerspective
| العنوان: | Treating lower extremity malperfusion syndrome in acute type A aortic dissection with endovascular revascularization followed by delayed aortic repairCentral MessagePerspective |
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| المؤلفون: | 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 |
| المصدر: | JTCVS Open, Vol 10, Iss , Pp 101-110 (2022) |
| بيانات النشر: | Elsevier, 2022. |
| سنة النشر: | 2022 |
| المجموعة: | LCC:Diseases of the circulatory (Cardiovascular) system LCC:Surgery |
| مصطلحات موضوعية: | lower extremity, malperfusion syndrome, aortic dissection, endovascular, open aortic repair, Diseases of the circulatory (Cardiovascular) system, RC666-701, Surgery, RD1-811 |
| الوصف: | 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: |
| نوع الوثيقة: | article |
| وصف الملف: | electronic resource |
| اللغة: | English |
| تدمد: | 2666-2736 |
| Relation: | http://www.sciencedirect.com/science/article/pii/S266627362200078X; https://doaj.org/toc/2666-2736 |
| DOI: | 10.1016/j.xjon.2022.02.017 |
| URL الوصول: | https://doaj.org/article/d37c05758a134c20a9d76658e5cb3f7b |
| رقم الأكسشن: | edsdoj.37c05758a134c20a9d76658e5cb3f7b |
| قاعدة البيانات: | Directory of Open Access Journals |
Full Text via ClinicalKey 
Full Text Finder | تدمد: | 26662736 |
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| DOI: | 10.1016/j.xjon.2022.02.017 |