Spontaneous Resolution of Lower Extremity Hypoperfusion in Type B Aortic Dissection: A Case Report

Abstract

Lower extremity hypoperfusion occurs in 5.7-30% of Stanford type B aortic dissection cases. A 53-year-old male patient presented with type B aortic dissection. His left femoral pulse was not palpable. The proximal left common iliac artery was nearly occluded in computed tomography angiography. There was no extremitythreatening rest pain, but there was intermittent claudication at 100 meters. Cross femoral bypass was planned for the patient under elective conditions. After two months, the left femoral pulse was palpable, and the patient no longer had intermittent claudication. In this study, we report that lower extremity hypoperfusion, which developed after acute type B aortic dissection resolved without open and endovascular surgery.

Keywords

• Dissection
• lower extremity
• reperfusion
• intermittent claudication

References

1. 1. Nauta FJ, Trimarchi S, Kamman AV, Moll FL, Herwaarden JA, Patel HJ, et al. Update in the management of type B aortic dissection. Vasc Med 2016;21(3):251-63. [Crossref]
2. 2. Fattori R, Cao P, De Rango P, Czerny M, Evangelista A, Nienaber C, et al. Interdisciplinary expert consensus document on management of type B aortic dissection. J Am Coll Cardiol 2013;61:1661-78. [Crossref]
3. 3. Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo R, Eggebrecht Hi et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC) [published correction appears in Eur Heart J 2015 Nov 1;36(41):2779]. Eur Heart J 2014;35(41):2873-926. [Crossref]
4. 4. Andacheh ID, Donayre C, Othman F, Walot I, Kopchok G, White R. Patient outcomes and thoracic aortic volume and morphologic changes following thoracic endovascular aortic repair in patients with complicated chronic type B aortic dissection. J Vasc Surg 2012;56(3):644-50. [Crossref]
5. 5. White RA, Miller DC, Criado FJ, Dake MD, Diethrich EB, Greenberg RK, et al. Report on the results of thoracic endovascular aortic repair for acute, complicated, type B aortic dissection at 30 days and 1 year from a multidisciplinary subcommittee of the Society for Vascular Surgery Outcomes Committee. J Vasc Surg 2011;53(4):1082-90. [Crossref]
6. 6. Gargiulo M, Massoni CB, Gallitto E, Freyrie A, Trimarchi S, Faggioli G, et al. Lower limb malperfusion in type B aortic dissection: A systematic review. Ann Cardiothorac Surg 2014;3(4):351-67.
7. 7. Suzuki T, Mehta RH, Ince H, Nagai R, Sakomura Y, Weber F, et al. Clinical profiles and outcomes of acute type B aortic dissection in the current era: Lessons from the International Registry of Aortic Dissection (IRAD). Circulation 2003;108 Suppl 1:II312-7. [Crossref]
8. 8. Lakshmanan R, Aung M, Hoong CK. Limb ischaemia in a Stanford B aortic dissection into an abdominal aortic aneurysm. ANZ J Surg 2008;78:660-1. [Crossref]

9. 9. Plotkin A, Vares-Lum D, Magee GA, Han SM, Fleischman F, Rowe VL. Management strategy for lower extremity malperfusion due to acute aortic dissection. J Vasc Surg 2021;74(4):1143-51. [Crossref]
10. 10. Williams DM, Lee DY, Hamilton BH, Marx MV, Narasimham DL, Kazanjian SN, et al. The dissected aorta: Part III. Anatomy and radiologic diagnosis of branch-vessel compromise. Radiology 1997;203:37-44. [Crossref]