Acute thrombolysis in a patient with Type A aortic dissection and critical leg ischemia in an Arctic country

A man in his early 50s presented at a remote hospital in Arctic Greenland with sudden severe chest and back pain, followed by critical ischemia in the right leg. Bedside ultrasound showed cessation of Doppler flow in the femoral artery, while ECG was normal. Aortic dissection was suspected, but lacking CT-scanner, MRI-scanner, or transesophageal ultrasound, the diagnosis could not be confirmed. The patient was treated symptomatically with thrombolysis for suspected femoral artery thrombosis. Overnight, the right leg regained color and pulses. The next day, weather circumstances allowed transfer to a secondary hospital, and CT-angiography showed a Type A aortic dissection extending from the aortic valve to both femoral arteries. Thrombolysis was stopped, and the patient was transferred and underwent surgery abroad at a specialized hospital. Despite 55-hour delay, the patient had a favorable outcome, returning to work 8 weeks post-surgery. This case highlights the diagnostic challenges in remote settings.