Type A aortic dissection into brachial artery causing upper limb ischaemia: A case report

INTRODUCTION: Acute type A aortic dissection (AAAD) is a surgical emergency with high operative mortality. Distal propogration of the dissecting flap can lead to malperfusion of territory supplied by the aorta including axillary and brachial arteries causing ischaemia of the upper limb. CASE PRESENTATION: We present a case of a 67 year old gentleman who had AAAD and developed upper limb malperfusion after repair. Despite adequate repair, the residual dissecting flap propagated distally in the upper arm vasculature causing thombosis of the brachial artery. The patient subsequently underwent brachial artery cut-down and embolectomy but revascularization was not achieved. He ultimately required an above-elbow amputation. CONCLUSION: Upper limb ischaemia from AAAD is a rare phenomenon that is mainly due to malperfusion. Majority of malperfusion resolve after aortic dissection repair. This is an unusual case of persistent upper limb ischaemia despite adequate repair due to the direct extension of the residual dissection flap from the aortic root into the brachial artery.