Analysis of Factors Affecting Limb Function Recovery Following Surgery for Acute Type A Aortic Dissection Complicated by Lower Extremity Malperfusion: A Retrospective Study

Background: This study aims to analyze the clinical characteristics and factors influencing postoperative limb function recovery in patients with acute type A aortic dissection (ATAAD) complicated by lower extremity malperfusion (LEM). The objective is to accurately assess preoperative conditions, identify and manage risk factors, improve surgical techniques, and offer insights to enhance the recovery rate of LEM following surgery. Methods: This retrospective study included 131 patients with ATAAD complicated by LEM, admitted to the Department of Cardiothoracic Surgery at Nanjing Drum Tower Hospital between January 2013 and June 2019. Based on the resolution of lower extremity malperfusion postoperatively, patients were divided into a recovery group (n = 80) and a non-recovery group (n = 51). The preoperative limb status and general condition of both groups were evaluated, and factors influencing limb function recovery were analyzed using univariate and multivariate logistic regression. Results: Univariate analysis revealed statistically significant differences between the recovery and non-recovery groups for various variables. These included ischemic symptoms (odds ratio [OR] = 3.841, 95% confidence interval [CI] 1.850–8.197, p < 0.001), paresthesia (OR = 2.197, 95% CI 1.080–4.538, p = 0.031), decreased muscle strength (OR = 2.594, 95% CI 1.203–5.688, p = 0.016), decreased skin temperature (OR = 2.475, 95% CI 1.205–5.162, p = 0.014), non-detectable limb blood pressure (OR = 2.667, 95% CI 1.270–5.692, p = 0.010), prolonged cardiopulmonary bypass time (OR = 1.008, 95% CI 1.003–1.014, p = 0.002), prolonged aortic occlusion time (OR = 1.008, 95% CI 1.001–1.014, p = 0.018), and the requirement for continuous renal replacement therapy (CRRT) (OR = 8.095, 95% CI 3.620–19.165, p < 0.001). There were no significant differences between the groups in terms of gender, age, body mass index (BMI), absence of limb numbness or pain, skin pallor or mottling, absence of femoral or dorsalis pedis pulses, or non-detectable lower limb blood pressure (p > 0.05). Multivariate logistic regression identified ischemic symptoms (OR = 4.519, 95% CI 1.910–11.320, p = 0.001), non-measurable blood pressure (OR = 2.720, 95% CI 1.093–6.996, p = 0.033), and prolonged cardiopulmonary bypass time (OR = 1.018, 95% CI 1.006–1.034, p = 0.011) as independent early predictors of failure to recover limb function in patients with ATAAD. Conclusion: In ATAAD patients presenting with lower extremity ischemia at admission, healthcare providers should maintain heightened vigilance for postoperative ischemia, especially in cases with bilateral limb ischemia and non-measurable blood pressure. Early identification of these risk factors may contribute to enhancing postoperative outcomes.