Acute Aortic Dissection Presenting as Left Upper Limb Ischemia

Abstract

Acute upper limb ischemia is most frequently the result of an embolus that originates in the heart. Ascending aortic dissection is a life-threatening vascular emergency that must be treated immediately. Isolated upper limb ischemia secondary to acute aortic dissection has not been previously reported.

Two cases of DeBakey type I aortic dissection presenting as unilateral upper limb ischemia are reported. This presentation may result in delayed diagnosis of aortic dissection and, consequently, in high mortality. The possibility should be borne in mind when dealing with all cases of acute arm ischemia because embarking on a brachial embolectomy which may delay the diagnosis of a more serious and fatal condition. The etiology of this unusual presentation and possible therapeutic interventions are discussed.

Get full access to this article

View all access options for this article.

References

1. McFadden PM , Ochsner JL : Surgical technique for aortic dissection. In: Chapman, Hall (eds): Rob and Smith's Operative Vascular Surgery, ed. 5. London: 1994, pp 163-179.

2. Sadeghi H : Long-term treatment of patients with dissection of the thoracic aorta. Schweiz Med Wochenschr 123:2033-2036, 1993.

3. Kovarsky S , Bessou JP , Olaya L , et al: A case of type I aortic dissection presenting as bilateral lower limb ischemia: Discussion of surgical strategy. J Mal Vasc 18:323-326, 1993.

4. Krishnamwithy P , Chandrasekaran K , Rodriguez Vego JR , Grunewald R : Acute thoracic aortic occlusion resulting from complex aortic dissection and presenting as paraplegia. J Thorac Imaging 9:101-104, 1994.

5. Dale WA : Differential management of acute peripheral arterial ischemia. J Vasc Surg 1:269-269, 1984.

6. Larrain E , Irarrazoval MJ , Zalaquett R , et al: Dissection of the ascending aorta (type A): Diagnostic aspects, surgical treatment and long-term follow-up. Rev Med Chil 120:1376-1382, 1992.

7. Veith FJ : Transluminally placed endovascular stented grafts and their impact on vascular surgery. J Vasc Surg 20:855-860, 1994.