Dissecting hematoma presents as acute lower limb ischemia: diagnostic patient profile and management.

Three unusual cases with dissecting hematoma of the thoracic aorta, presenting solely with unilateral ischemia of the right lower extremity, are described. The world literature is reviewed. We present the following patient profile to facilitate the diagnosis: (1) hypertensive middle aged black male, or (2) young white male with stigmata of Marfan's syndrome, both complaining of sudden unilateral ischemia of the right lower extremity. Common causes of acute arterial occlusion are absent. The diagnosis, once suspected, must be confirmed by immediate angiography before planning the treatment for the limb ischemia. We advocate femoro-femoral bypass to relieve acute limb-threatening when definitive management involves delay in scheduling or requires transfer to another institution.