Acute Type A Aortic Dissection With Compartment Syndrome.

BACKGROUND

Malperfusion syndrome (MPS) and acute compartment syndrome (ACS) complicating acute type A aortic dissection (ATAAD) are lethal conditions. Despite the restoration of true lumen flow following successful surgical or endovascular interventions, patients may succumb to metabolic abnormalities and end-organ failure.

CASE SUMMARY: This case presents a series of therapies for ATAAD accompanied by severe MPS and ACS of the lower extremity. Immediate open repair surgery was performed to prevent aortic rupture and reopen the visceral artery, and endovascular treatment ensured limb reperfusion. Fasciotomy was performed for ACS with compartment decompression, and continuous blood purification facilitated the restoration of organ function.

DISCUSSION: Proximal aortic repair is unlikely to completely restore perfusion to aortic branch vessels in cases of ischemia caused by dissection-related obstruction. A multimodal management strategy, encompassing medical therapy, urgent open repair, endovascular stenting, fasciotomy, continuous blood purification, and a multimodal team, may effectively salvage the patient.

TAKE-HOME MESSAGES: ATAAD is an emergent and potentially fatal disease, particularly complicated by MPS. A multimodal management strategy may yield satisfactory clinical outcomes.