Correlation Analysis Between Four-limb Blood Pressure Difference And Diagnosis And Prognosis Of Acute Type A Aortic Dissection

Background:Aortic dissection is a very dangerous aortic syndrome caused by tearing of the aortic wall due to various reasons with an incidence rate of about 6/100,000.However,the incidence rate of aortic dissection has been underestimated due to the high mortality rate.Four-limb blood pressure difference may occur when the aortic dissection involves the subclavian artery or the arteria iliaca communis,and it is used to be an early identification indicator for suspicious aortic dissection.Malperfusion syndrome is an important risk factor of the death in aortic dissection,including the malperfusion of the coronary artery,brain mesenteric,kidneys,spinal cord,and limbs.As a favorable indicator of limb perfusion,whether the four-limb blood pressure is related to the higher incidence rate of the malperfusion syndrome and worse prognosis remains unknown.Objective:This project aims to explore the relationship between four-limb blood pressure difference and the incidence rate of the malperfusion syndrome and prognosis.Method:This study reviewed all patients diagnosed with aortic dissection from January 2019 to January 2021 in the Department of Cardiovascular Surgery,Nanfang Hospital,Southern Medical University.The general condition,history,clinical symptoms,blood test examination,surgery,postoperative complications,and prognosis of all the included patients were recorded.All the study population was divided into two groups based on the presence of four-limb blood pressure difference.Clinical data were statistically analyzed using SPSS25.0 software.The difference between both groups was compared using the chi-square test or t-test or rank-sum test.Logistic multivariate regression analysis was used to explore independent risk factors of in-hospital death in patients with acute type A aortic dissection.Result:A total of 87 patients were enrolled in this study,72.4%of patients had four-limb blood pressure difference.There was no significant difference in hospital mortality between both groups(19%vs 20.8%),but there were longer hospitalization days(23(15,28)vs(17.5(8.5,26))and postoperative intensive care unit(ICU)duration days(6(4,10)vs 4.5(3,7))in the group of four-limb blood pressure difference.One or both of the brachiocephalic trunk or subclavian arteries had the aortic dissection in the 84%of patients when inter-arm blood pressure difference existed.one or bilateral common iliac arteries had the aortic dissection in 82%of patients when inter-leg blood pressure difference existed.A higher incidence rate of organ malperfusion could be found in the group of fourlimb blood pressure difference(82.6%vs 17.4%,p=0.024).62.7%of patients of inter-arm blood pressure difference had organ malperfusion;79.3%of patients of inter-leg blood pressure difference had organ malperfusion;52.3%of patients whose arm blood pressure exceed leg blood pressure had organ malperfusion.Logistic multi-factor regression analysis demonstrated that brain malperfusion,inter-leg blood pressure difference,history of previous heart or aortic surgery,postoperative cerebrovascular events were independent risk factors for in-hospital death of patients with acute type A aortic dissection.Conclusion:Patients with four-limb blood pressure difference have longer hospitalization and postoperative ICU duration.Besides,the four-limb blood pressure difference is related to the higher incidence rate of malperfusion syndrome.The patients with inter-leg blood pressure difference have a higher incidence rate of malperfusion and higher in-hospital mortality,and inter-leg blood pressure can be a favorable indicator for the prognosis of acute type A aortic dissection.