Abstract
A 49-year-old man was admitted with sudden onset of epigastralgia, lumbar pain, and pain in his legs. Computed tomography (CT) revealed type A aortic dissection with narrowing of the true lumen, which was compressed by a false lumen at the level of the descending and abdominal aorta. Pulsation in either leg was not palpable as the site of femoral arteries, but aortic branches to visceral organs, including renal arteries, and those of lower extremities were all equally enhanced by contrast medium on CT films. Emergency operation to replace the ascending aorta was performed under hypothermic circulatory arrest and retrograde cerebral perfusion. Postoperatively, the pulse in the lower extremities improved to some extent but was still weak, and malperfusion in kidneys and other visceral organs was suggested by anuria and by changes in the results of blood analysis. On the day after the primary surgery, left axillo-left femoral bypass was performed. After this additional procedure, the pulse in the lower limbs became similar to those of upper limbs, and the anuria disappeared. The recovery of the patient was uneventful thereafter. In this case, it seemed that this additional minor procedure worked effectively to treat the potentially life-threatening ischemic complications of acute aortic dissection.
