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Abstract：
UNASSIGNED: Data regarding management of lower-extremity malperfusion in the setting of type A aortic dissection are limited. This study aimed to compare acute type A aortic dissection with lower-extremity malperfusion outcomes in patients undergoing lower-extremity revascularization with no revascularization.
UNASSIGNED: Consecutive patients undergoing acute type A aortic dissection surgery were identified from a prospectively maintained database. Perioperative variables were compared between patients with and without lower-extremity malperfusion. Factors associated with lower-extremity malperfusion, revascularization, and mortality were determined using univariable Cox regression and Firth\'s penalized likelihood modeling.
UNASSIGNED: From January 2007 to December 2021, 601 patients underwent proximal aortic repair for acute type A aortic dissection at a quaternary care center. Of these, 85 of 601 patients (14%) presented with lower-extremity malperfusion and were more often male (P = .02), had concomitant moderate or greater aortic insufficiency (P = .05), had lower ejection fraction (P = .004), had preoperative dialysis dependence (P = .01), and had additional cerebral, visceral, and renal malperfusion syndromes (P < .001). Kaplan-Meier estimated survival fared worse with lower-extremity malperfusion compared with no lower-extremity malperfusion at 1, 5, and 10 years (84% vs 77%, 74% vs 71%, 65% vs 52%, respectively, P = .03). In the lower-extremity malperfusion group, 15 of 85 patients (18%) underwent lower-extremity revascularization without significant differences in postoperative morbidity and mortality compared with patients not undergoing revascularization. Need for peripheral revascularization was associated with peripheral vascular disease (hazard ratio, 3.7 [1.0-14.0], P = .05) and pulse deficit (hazard ratio, 5.6 [1.3-24.0], P = .02) at presentation.
UNASSIGNED: Patients presenting with type A aortic dissection and lower-extremity malperfusion have worse overall survival compared with those without lower-extremity malperfusion. However, not all patients with type A aortic dissection and lower-extremity malperfusion require revascularization.
UNASSIGNED: Consecutive patients undergoing acute type A aortic dissection surgery were identified from a prospectively maintained database. Perioperative variables were compared between patients with and without lower-extremity malperfusion. Factors associated with lower-extremity malperfusion, revascularization, and mortality were determined using univariable Cox regression and Firth\'s penalized likelihood modeling.
UNASSIGNED: From January 2007 to December 2021, 601 patients underwent proximal aortic repair for acute type A aortic dissection at a quaternary care center. Of these, 85 of 601 patients (14%) presented with lower-extremity malperfusion and were more often male (P = .02), had concomitant moderate or greater aortic insufficiency (P = .05), had lower ejection fraction (P = .004), had preoperative dialysis dependence (P = .01), and had additional cerebral, visceral, and renal malperfusion syndromes (P < .001). Kaplan-Meier estimated survival fared worse with lower-extremity malperfusion compared with no lower-extremity malperfusion at 1, 5, and 10 years (84% vs 77%, 74% vs 71%, 65% vs 52%, respectively, P = .03). In the lower-extremity malperfusion group, 15 of 85 patients (18%) underwent lower-extremity revascularization without significant differences in postoperative morbidity and mortality compared with patients not undergoing revascularization. Need for peripheral revascularization was associated with peripheral vascular disease (hazard ratio, 3.7 [1.0-14.0], P = .05) and pulse deficit (hazard ratio, 5.6 [1.3-24.0], P = .02) at presentation.
UNASSIGNED: Patients presenting with type A aortic dissection and lower-extremity malperfusion have worse overall survival compared with those without lower-extremity malperfusion. However, not all patients with type A aortic dissection and lower-extremity malperfusion require revascularization.
摘要：
■关于在A型主动脉夹层中处理下肢灌注不良的数据有限。这项研究旨在比较急性A型主动脉夹层与下肢血流不良的结果在接受下肢血运重建而没有血运重建的患者。
■从前瞻性维护的数据库中确定连续接受急性A型主动脉夹层手术的患者。比较了有和没有下肢灌注不良的患者的围手术期变量。与下肢灌注不良相关的因素，血运重建,使用单变量Cox回归和Firth的惩罚似然模型确定死亡率。
■从2007年1月到2021年12月，601例患者在四级护理中心接受了急性A型主动脉夹层的近端主动脉修复术。其中,601例患者中有85例（14％）出现下肢灌注不良，男性更常见（P=0.02），伴有中度或重度主动脉瓣关闭不全（P=0.05），射血分数较低（P=.004），有术前透析依赖性（P=0.01），并且有额外的大脑，内脏，肾灌注不良综合征（P<0.001）。Kaplan-Meier估计，在1年、5年和10年，下肢灌注不良与无下肢灌注不良相比，生存率更差（84%vs77%，74%vs71%，65%vs52%，分别,P=.03）。下肢灌注不良组,85例患者中有15例（18％）接受了下肢血运重建，与未接受血运重建的患者相比，术后发病率和死亡率没有显着差异。外周血运重建的需要与外周血管疾病相关(风险比，3.7[1.0-14.0],P=0.05)和脉搏不足(危险比，5.6[1.3-24.0]、P=.02）在演示中。
■患有A型主动脉夹层和下肢灌注不良的患者与没有下肢灌注不良的患者相比，总生存期更差。然而,并非所有A型主动脉夹层和下肢灌注不良的患者都需要血运重建。
■从前瞻性维护的数据库中确定连续接受急性A型主动脉夹层手术的患者。比较了有和没有下肢灌注不良的患者的围手术期变量。与下肢灌注不良相关的因素，血运重建,使用单变量Cox回归和Firth的惩罚似然模型确定死亡率。
■从2007年1月到2021年12月，601例患者在四级护理中心接受了急性A型主动脉夹层的近端主动脉修复术。其中,601例患者中有85例（14％）出现下肢灌注不良，男性更常见（P=0.02），伴有中度或重度主动脉瓣关闭不全（P=0.05），射血分数较低（P=.004），有术前透析依赖性（P=0.01），并且有额外的大脑，内脏，肾灌注不良综合征（P<0.001）。Kaplan-Meier估计，在1年、5年和10年，下肢灌注不良与无下肢灌注不良相比，生存率更差（84%vs77%，74%vs71%，65%vs52%，分别,P=.03）。下肢灌注不良组,85例患者中有15例（18％）接受了下肢血运重建，与未接受血运重建的患者相比，术后发病率和死亡率没有显着差异。外周血运重建的需要与外周血管疾病相关(风险比，3.7[1.0-14.0],P=0.05)和脉搏不足(危险比，5.6[1.3-24.0]、P=.02）在演示中。
■患有A型主动脉夹层和下肢灌注不良的患者与没有下肢灌注不良的患者相比，总生存期更差。然而,并非所有A型主动脉夹层和下肢灌注不良的患者都需要血运重建。
