Femoral artery cannulation during salvage surgery in patients with type A aortic dissection: A retrospective study

Femoral artery cannulation is commonly used in emergency surgery for type A aortic dissection (TAAD) because of its convenience. However, patients with pre-existing lower limb ischemia undergoing femoral artery cannulation may face additional risks. This study aimed to comprehensively evaluate the short- and long-term outcomes associated with cannulation in ischemic femoral arteries (C-IFA). A retrospective analysis was conducted involving patients with acute type A aortic dissection and lower-limb ischemia who underwent emergency surgery. The primary outcome was overall mortality, while secondary outcomes included permanent limb dysfunction, permanent dialysis, intensive care unit stays exceeding 10 days, and mechanical ventilation duration exceeding 96 h. Patients were stratified into two groups based on whether they underwent cannulation in the ischemic femoral artery in both the original and propensity score (PS)-matched cohorts. 92 patients, with a mean age of 53.78 ± 12.58 years, were included. The median follow-up period was 31.0 months. No significant differences were observed in the primary (P = 0.083 and P = 0.100, respectively) and secondary endpoints (P = 0.249 and P = 0.332, respectively) between the two groups in both the original and PS-matched cohorts. Age (hazard ratio [HR]: 1.07) and permanent dialysis (HR: 4.10) were identified as independent risk factors for the primary outcome. Subgroup analysis indicated that male sex, hypertension, and bilateral lower-limb ischemia may derive benefits from avoiding C-IFA. Patients may benefit from avoiding C-IFA whenever possible. However, obtaining surgical timing via C-IFA is not entirely unacceptable, particularly in cases where the patient presents with bilateral lower-limb ischemia and requires rescue.