Suliman, AASulimanDialynas, MMDialynasAshrafian, HHAshrafianBicknell, CCBicknellMireskandari, MMMireskandariHamady, MMHamadyAthanasiou, TTAthanasiou2016-09-192010-01-282016-09-192010-01-28Journal of Cardiothoracic Surgery, 2010, 51749-8090http://hdl.handle.net/10044/1/40314Acute type A aortic dissection can be complicated by visceral malperfusion and is associated with a significant surgical morbidity and mortality. We describe a case of successful management of a complex acute type A dissection with mesenteric and lower limb ischemia treated with endovascular thoracic stenting and femoro-femoral crossover bypass grafting followed by aortic arch repair. To accomplish this, we applied a staged therapeutic approach using serial lactate measurements to assess the adequacy of peripheral perfusion and metabolic status prior to surgical repair of the proximal dissection.© Suliman et al. 2010. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Science & TechnologyLife Sciences & BiomedicineCardiac & Cardiovascular SystemsCardiovascular System & CardiologyCARDIAC & CARDIOVASCULAR SYSTEMSAORTIC DISSECTIONVASCULAR COMPLICATIONSINTESTINAL ISCHEMIASURGICAL DELAYMANAGEMENTAneurysm, DissectingAortic Aneurysm, ThoracicBiomarkersClinical ProtocolsFemoral ArteryHumansIschemiaLactic AcidLegMaleMiddle AgedStentsSyndromeTreatment OutcomeBiological MarkersRespiratory System1103 Clinical SciencesJournal Articlehttps://www.dx.doi.org/10.1186/1749-8090-5-4