Yong Zachary Zihui, Chin Andrew Yuan Hui
Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore.
Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore.
Int J Surg Case Rep. 2021 Feb;79:479-483. doi: 10.1016/j.ijscr.2021.01.074. Epub 2021 Jan 28.
Acute type A aortic dissection (AAAD) is a surgical emergency with high operative mortality. Distal propogration of the dissecting flap can lead to malperfusion of territory supplied by the aorta including axillary and brachial arteries causing ischaemia of the upper limb.
We present a case of a 67 year old gentleman who had AAAD and developed upper limb malperfusion after repair. Despite adequate repair, the residual dissecting flap propagated distally in the upper arm vasculature causing thombosis of the brachial artery. The patient subsequently underwent brachial artery cut-down and embolectomy but revascularization was not achieved. He ultimately required an above-elbow amputation.
Upper limb ischaemia from AAAD is a rare phenomenon that is mainly due to malperfusion. Majority of malperfusion resolve after aortic dissection repair. This is an unusual case of persistent upper limb ischaemia despite adequate repair due to the direct extension of the residual dissection flap from the aortic root into the brachial artery.
急性A型主动脉夹层（AAAD）是一种手术急症，手术死亡率高。夹层瓣的远端扩展可导致由主动脉供血的区域（包括腋动脉和肱动脉）灌注不良，从而引起上肢缺血。
我们报告一例67岁男性患者，患有AAAD，修复后出现上肢灌注不良。尽管修复充分，但残余的夹层瓣在上臂血管系统中向远端扩展，导致肱动脉血栓形成。患者随后接受了肱动脉切开取栓术，但未实现血管再通。他最终需要进行肘上截肢。
AAAD导致的上肢缺血是一种罕见现象，主要是由于灌注不良。大多数灌注不良在主动脉夹层修复后得到缓解。这是一例不寻常的病例，尽管修复充分，但由于残余夹层瓣从主动脉根部直接延伸至肱动脉，导致上肢持续缺血。
