# Acute thrombolysis in a patient with Type A aortic dissection and critical leg ischemia in an Arctic country

## TL;DR

A man in Greenland with aortic dissection and leg ischemia was treated with thrombolysis before diagnosis, leading to a successful outcome despite delays.

## Contribution

This case study presents a rare clinical scenario in a remote Arctic setting with limited diagnostic resources.

## Key findings

- Thrombolysis improved leg ischemia before aortic dissection was confirmed.
- The patient had a favorable outcome despite a 55-hour delay in definitive diagnosis and surgery.
- Diagnostic challenges in remote areas were highlighted.

## Abstract

A man in his early 50s presented at a remote hospital in Arctic Greenland with sudden severe chest and back pain, followed by critical ischemia in the right leg. Bedside ultrasound showed cessation of Doppler flow in the femoral artery, while ECG was normal. Aortic dissection was suspected, but lacking CT-scanner, MRI-scanner, or transesophageal ultrasound, the diagnosis could not be confirmed. The patient was treated symptomatically with thrombolysis for suspected femoral artery thrombosis. Overnight, the right leg regained color and pulses. The next day, weather circumstances allowed transfer to a secondary hospital, and CT-angiography showed a Type A aortic dissection extending from the aortic valve to both femoral arteries. Thrombolysis was stopped, and the patient was transferred and underwent surgery abroad at a specialized hospital. Despite 55-hour delay, the patient had a favorable outcome, returning to work 8 weeks post-surgery. This case highlights the diagnostic challenges in remote settings.