Article in Press
Back to the articles list |
Back to browse issues page
Department of Emergency Medicine, Sina hospital, Tehran University of Medical Sciences, Tehran, Iran
Abstract: (30 Views)
Type A aortic dissection (TAAD) is a medical emergency that can lead to catastrophic complications, including malperfusion of vital organs and extremities. Popliteal artery embolism as a result of TAAD is rare but can result in acute limb ischemia, which carries a high risk of limb loss if not promptly addressed. This study aimed to present a case of a 72-year-old male with a history of hypertension and hyperlipidemia who presented to the emergency department with sudden-onset, severe chest pain radiating to his back and acute pain and coldness in his right lower extremity. Physical examination revealed a pale, cool, and pulseless right lower extremity with diminished sensation and motor function. Initial imaging, including transthoracic echocardiography and computed tomography angiography, confirmed TAAD with a thrombus occluding the right popliteal artery. In transthoracic echocardiography, the aortic valve appeared structurally normal with no evidence of regurgitation or stenosis. The patient underwent emergent surgical repair of the aortic dissection and thrombectomy of the popliteal artery, with successful revascularization and transfer to the intensive care unit postoperatively. This case highlighted the rare but critical complication of acute limb ischemia secondary to TAAD, emphasizing the importance of a high index of suspicion for aortic dissection in patients presenting with limb ischemia, particularly in the presence of risk factors. A multidisciplinary approach involving early imaging, prompt surgical intervention, and limb revascularization is crucial to improving outcomes. Despite advances in management, acute limb ischemia due to TAAD remains associated with high morbidity and mortality, underscoring the need for further research to optimize diagnostic and therapeutic strategies.
Type of Study: Case Report |
Subject:
Emergency Medicine
Received: 2025/05/11 | Accepted: 2025/06/24 | ePublished ahead of print: 2025/08/4
Received: 2025/05/11 | Accepted: 2025/06/24 | ePublished ahead of print: 2025/08/4
References
1. Brown JA, Aranda-Michel E, Navid F, Serna-Gallegos D, Thoma F, Sultan I. Outcomes of emergency surgery for acute type A aortic dissection complicated by malperfusion syndrome. J Thorac Cardiovasc Surg. 2024;167(3):882-92. [DOI:10.1016/j.jtcvs.2022.04.051]
2. Sapalo AT. Combined Ultrasound in Screening. In: Smith DL, Johnson RW, editors. Advances in Vascular Surgery: From the Diagnostic Phase to the Use of Hybrid and Endovascular Techniques in the Management of Aortic Dissection. 1st ed. New York: Springer; 2025.
3. Hirao Y, Fujiuchi B, Benavente K, Morihara C, Sakamoto A, Itoga N, et al. Acute Limb Ischemia Presenting as a Clinical Conundrum: Stroke Mimic or Aortic Dissection? European journal of case reports in internal medicine. 2025;12(4):005317. [DOI:10.12890/2025_005317]
4. Patel NN, Kurnick A, Bukharovich I. Atypical presentation of a type a aortic dissection in a patient with an undiagnosed genetic predisposition. Cureus. 2024;16(3):e56394. [DOI:10.7759/cureus.56394]
5. Jaffar-Karballai M, Tran TT, Oremakinde O, Zafar S, Harky A. Malperfusion in acute type A aortic dissection: management strategies. J Vasc Endovasc Surg. 2021;55(7):721-9. [DOI:10.1177/15385744211017116]
6. Bossone E, Eagle KA. Epidemiology and management of aortic disease: aortic aneurysms and acute aortic syndromes. Nat Rev Cardiol. 2021;18(5):331-48. [DOI:10.1038/s41569-020-00472-6]
7. 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. [DOI:10.1016/j.jvs.2021.04.032]
8. Zhang Y, Chen T, Chen Q, Min H, Nan J, Guo Z. Development and evaluation of an early death risk prediction model after acute type A aortic dissection. Ann Transl Med. 2021;9(18):1442. [DOI:10.21037/atm-21-4063]
9. Natour AK, Rteil A, Shepard A, Weaver M, Nypaver T, Nemeh H, et al. Outcomes of patients with acute type A aortic dissection and concomitant lower extremity malperfusion. J Vasc Surg. 2022;76(3):631-8. [DOI:10.1016/j.jvs.2022.03.888]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
Attribution-NoneCommercial CC BY-NC
