Surgical correction of visceral-organ and lower-limb malperfusion syndrome in patients with aortic dissection

Karpenko A.A., Chernyavskii A.M., Starodubtsev V.B., Chernyavskii M.A., Valentik A.V.

Centre of Vascular and Hybrid Surgery,Federal State Facility «Novosibirsk Scientific Research Institute for Circulatory Pathology named after Academician E.N. Meshalkin under the ministry of Public Health and Social Development of the Russian Federation, Novosibirsk, Russia

The article deals with the experience gained in treatment of 28 patients presenting with type I and III aortic dissection (according to DeBakey) complicated by visceral-organ and lower-limb malperfusion syndrome. Those presenting with type I aortic dissection were subjected to reconstructive operations on the aortic arch as the first stage. The events of renal insufficiency and abdominal ischaemia were coped with and relieved using by-passing operations on the visceral branches – iliac-renal, ilac-renal-mesenteric by-pass grafting. In two cases in acute ischaemia of the lower limbs we performed aorto-bi-iliac prosthetic repair. In one case we revealed thrombosis of the iliac-renal by-pass, also performing iliac-renal re-do shunting. No other complications during surgical interventions were observed, neither were any lethal outcomes encountered. Bypassing operations on the visceral and renal arteries in patients with aortic dissection make it possible to eliminate both abdominal and renal ischaemia as well as malperfusion of lower extremities.

KEY WORDS: aortic dissection, visceral organ malperfusion.

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