A novel approach for lower extremity malperfusion in type A aortic dissection: A case report

Lower extremity malperfusion (LEM) is a severe complication of type A aortic dissection, often leading to ischemia and increased mortality. Optimal management remains debated, with limb-first and aortic dissection-first approaches under consideration. A 53-year-old male presented with syncope and signs of type A aortic dissection extending from the ascending aorta to the iliac bifurcation, causing dynamic LEM. To manage LEM while addressing the dissection, temporary distal perfusion was achieved using a 10F catheter connected to the femoral artery cannulation line during surgery. A Bentall procedure with hemiarch replacement was carried out (cardiopulmonary bypass time: 229 min). Postoperatively, the right lower extremity pulses were restored, and ischemia resolved without sequelae. Temporary perfusion via a central catheter from the cardiopulmonary bypass line offers a simple and effective solution to manage LEM during aortic dissection repair, potentially reducing ischemic complications. This approach may serve as a bridge to definitive repair, particularly in time-sensitive scenarios.