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
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)