Clinical Experience of Renal and Limb Malperfusion in DeBakey Type I Acute Aortic Dissection

Abstract

We describe 2 cases of DeBakey type I acute aortic dissection with renal and limb malperfusion. The mechanism of unilateral renal ischemia in both cases was the compression of the true lumen, resulting in a decrease of blood flow to the renal artery which branched from the true lumen. The contralateral kidney, which functioned normally without ischemia, was perfused from a renal artery which branched from the false lumen in Case 1 and from the true lumen in Case 2. Unilateral leg ischemia (Case 1) and bilateral leg ischemia (Case 2) occurred by the same mechanism as true lumen collapse. Both patients underwent emergency graft replacement of the ascending aorta and proximal arch including resection of the primary entry tear to re-establish antegrade blood flow into the true lumen. However, the postoperative course of each patient was quite different. In Case 1, the patient required hemodialysis because bilateral renal dysfunction developed. Perfusion to the right kidney markedly decreased after central aortic repair, and left renal dysfunction continued despite improved left renal arterial flow, leading to bilateral renal dysfunction. In contrast, Case 2 showed adequate urinary output without the need for hemodialysis, because perfusion to the normally functioning right kidney had been maintained during central aortic repair despite sustained left renal dysfunction. Limb ischemia was improved by central aortic repair without the need for additional revascularization in both cases.