Intermittent malperfusion of bilateral upper limbs - An uncommon presentation of Type A Acute Aortic Dissection (TAAD)

INTRODUCTION: Aortic dissection occurs following a tear in the tunica intima of the aortic wall resulting in blood entering between the intima and media. Type A aortic dissection can rarely manifest as upper limb malperfusion. CASE PRESENTATION: This is regarding a patient who presented with intermittent malperfusion of the bilateral upper limbs and was initially managed as acute limb ischemia. An attempt of embolectomy didn't yield any clots. Urgent imaging with computed tomography angiogram of bilateral upper limbs revealed type A aortic dissection (TAAD). DISCUSSION: TAAD is a surgical emergency which can rarely manifest as intermittent malperfusion of upper limbs. This could be explained by the dissection flap's dynamic obstruction of the right brachiocephalic trunk and left subclavian artery. CONCLUSION: In patients with a discrepancy in pulse between both limbs or intermittent ischemia of limbs, aortic dissection should be considered a differential diagnosis.