Comment
Rapid reestablishment of flow within the ascending aortic true lumen is paramount in alleviating
dynamic malperfusion syndromes occurring in up to 90 % who sustain an aortic dissection at the
time of aortic repair (1).
However, static and fixed malperfusion can persist despite aortic repair of
dissection. If static malperfusion is not managed immediately, it can be deadly regardless of
whether the malperfusion is addressed before or after aortic repair and removal of an intimal tear
(2,3). We believe that malperfusion should be addressed simultaneously at type A dissection
repair with growing advocacy (4,5). We modified our perfusion graft as an alternative technique
(figure1) to perfuse both extremities and systemic circulation expeditiously. This allowed
immediate reperfusion of the threatened limb during replacement of the ascending thoracic
aortic, thereby limiting irreversible limb ischemia.