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Abstract：
UNASSIGNED: To assess the outcomes of emergency revascularization with endovascular fenestration/stenting followed by delayed open aortic repair in patients with acute type A aortic dissection with lower extremity (LE) malperfusion syndrome (MPS); that is, necrosis and dysfunction of the lower extremity.
UNASSIGNED: From 1996 to 2019, among 760 consecutive acute type A aortic dissection patients 512 patients had no malperfusion syndrome (Non-MPS), whereas 26 patients had LE-MPS with/without renal MPS and underwent endovascular fenestration/stenting, open aortic repair, or both. Patients with coronary, cerebral, mesenteric, and celiac MPS, or managed with thoracic endovascular aortic repair, were excluded (n = 222). All patients with LE-MPS underwent upfront endovascular fenestration/stenting except 1 patient (with signs of rupture) who initially underwent emergency open aortic repair.
UNASSIGNED: Among the LE-MPS patients, 17 (65%) had LE pain, 15 (58%) had abnormal motor function with 8 (31%) having paralysis, 10 (38%) had LE pallor, 17 (65%) had LE paresthesia, and 20 (77%) had LE pulselessness. Of the 25 patients undergoing upfront endovascular fenestration/stenting, 16 went on to open aortic repair, 3 survived to discharge without aortic repair, and 6 died before aortic repair (3-aortic rupture and 3-organ failure). In-hospital mortality among all patients was significantly higher in the LE-MPS group (31% vs 6.3%; P = .0003). Among those undergoing open aortic repair, postoperative outcomes were similar between groups, including operative mortality (18% vs 6.5%; P = .10). LE-MPS was a significant risk factor for in-hospital mortality (odds ratio, 6.0 [1.9, 19]; P = .002).
UNASSIGNED: In acute type A aortic dissection, LE-MPS was associated with high in-hospital mortality. Emergency revascularization with endovascular fenestration/stenting followed by delayed open aortic repair may be a reasonable approach.
UNASSIGNED: From 1996 to 2019, among 760 consecutive acute type A aortic dissection patients 512 patients had no malperfusion syndrome (Non-MPS), whereas 26 patients had LE-MPS with/without renal MPS and underwent endovascular fenestration/stenting, open aortic repair, or both. Patients with coronary, cerebral, mesenteric, and celiac MPS, or managed with thoracic endovascular aortic repair, were excluded (n = 222). All patients with LE-MPS underwent upfront endovascular fenestration/stenting except 1 patient (with signs of rupture) who initially underwent emergency open aortic repair.
UNASSIGNED: Among the LE-MPS patients, 17 (65%) had LE pain, 15 (58%) had abnormal motor function with 8 (31%) having paralysis, 10 (38%) had LE pallor, 17 (65%) had LE paresthesia, and 20 (77%) had LE pulselessness. Of the 25 patients undergoing upfront endovascular fenestration/stenting, 16 went on to open aortic repair, 3 survived to discharge without aortic repair, and 6 died before aortic repair (3-aortic rupture and 3-organ failure). In-hospital mortality among all patients was significantly higher in the LE-MPS group (31% vs 6.3%; P = .0003). Among those undergoing open aortic repair, postoperative outcomes were similar between groups, including operative mortality (18% vs 6.5%; P = .10). LE-MPS was a significant risk factor for in-hospital mortality (odds ratio, 6.0 [1.9, 19]; P = .002).
UNASSIGNED: In acute type A aortic dissection, LE-MPS was associated with high in-hospital mortality. Emergency revascularization with endovascular fenestration/stenting followed by delayed open aortic repair may be a reasonable approach.
摘要：
UNASSIGNED：评估急性A型主动脉夹层伴下肢（LE）灌注不良综合征（MPS）患者的急诊血运重建加腔内开窗/支架置入后延迟开放主动脉修复术的结果；下肢坏死和功能障碍。
UNASSIGNED：从1996年到2019年，在760例连续的急性A型主动脉夹层患者中，有512例患者没有灌注不良综合征（Non-MPS），而有26例患者有/没有肾脏MPS的LE-MPS，并接受了血管内开窗/支架置入术，开放式主动脉修复术,或者两者兼而有之。冠心病患者，大脑，肠系膜,和乳糜泻MPS，或者用胸主动脉腔内修复术管理，被排除在外(n=222)。所有LE-MPS患者均接受了前期血管内开窗术/支架置入术，但1例患者（有破裂迹象）最初接受了紧急开放式主动脉修复术。
未经证实：在LE-MPS患者中，17（65%）有LE疼痛，15例（58%）运动功能异常，8例（31%）瘫痪，10人（38%）患有LE苍白，17人（65%）有LE感觉异常，20例(77%)患有LE无脉性。在接受血管内开窗术/支架术的25例患者中，16继续开放主动脉修复术，3人存活出院，没有进行主动脉修复，主动脉修复术前死亡6人（3-主动脉破裂和3-器官衰竭）。LE-MPS组所有患者的住院死亡率均显着较高（31％vs6.3％；P=.0003）。在接受开放式主动脉修复的患者中，术后结局相似,包括手术死亡率（18%vs6.5%；P=.10）。LE-MPS是住院死亡率的重要危险因素(比值比，6.0[1.9，19]；P=.002）。
未经批准：在急性A型主动脉夹层中，LE-MPS与高住院死亡率相关。急诊血管重建术结合血管内开窗/支架置入术，然后延迟开放主动脉修复术可能是一种合理的方法。
UNASSIGNED：从1996年到2019年，在760例连续的急性A型主动脉夹层患者中，有512例患者没有灌注不良综合征（Non-MPS），而有26例患者有/没有肾脏MPS的LE-MPS，并接受了血管内开窗/支架置入术，开放式主动脉修复术,或者两者兼而有之。冠心病患者，大脑，肠系膜,和乳糜泻MPS，或者用胸主动脉腔内修复术管理，被排除在外(n=222)。所有LE-MPS患者均接受了前期血管内开窗术/支架置入术，但1例患者（有破裂迹象）最初接受了紧急开放式主动脉修复术。
未经证实：在LE-MPS患者中，17（65%）有LE疼痛，15例（58%）运动功能异常，8例（31%）瘫痪，10人（38%）患有LE苍白，17人（65%）有LE感觉异常，20例(77%)患有LE无脉性。在接受血管内开窗术/支架术的25例患者中，16继续开放主动脉修复术，3人存活出院，没有进行主动脉修复，主动脉修复术前死亡6人（3-主动脉破裂和3-器官衰竭）。LE-MPS组所有患者的住院死亡率均显着较高（31％vs6.3％；P=.0003）。在接受开放式主动脉修复的患者中，术后结局相似,包括手术死亡率（18%vs6.5%；P=.10）。LE-MPS是住院死亡率的重要危险因素(比值比，6.0[1.9，19]；P=.002）。
未经批准：在急性A型主动脉夹层中，LE-MPS与高住院死亡率相关。急诊血管重建术结合血管内开窗/支架置入术，然后延迟开放主动脉修复术可能是一种合理的方法。
