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

Michalis N. Gionis, George Kaimasidis, Emmanouel Tavlas, Nikolaos Kontopodis, Marina Plataki, Alexandros Kafetzakis, Christos V. Ioannou

Am J Case Rep 2013; 14:52-57

DOI: 10.12659/AJCR.883793

Background: 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.

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