Acute Stanford type A aortic dissection (ATAAD) complicated by lower limb malperfusion represents a critical surgical challenge with high mortality. This study presents an intraoperative reperfusion protocol designed to simultaneously address aortic pathology and ischemic complications. In contrast to conventional strategies—either staged endovascular stenting (iliac/aortic) followed by delayed proximal aortic repair or upfront ascending/arch replacement with potential postoperative revascularization (femoro-femoral bypass/stenting)—this study integrates proximal aortic reconstruction under cardiopulmonary bypass (CPB) with immediate femoral artery cannulation (7F-14F) via a CPB side circuit. This approach achieves synchronized aortic repair and distal reperfusion, reducing lower limb ischemic duration from 4-6 hours (historical average) to under 90 minutes. Preliminary results from a single-center cohort demonstrate clinically meaningful improvements: early postoperative mortality decreased from 25-30% to 14.3%, with reductions in limb compartment syndrome (4.8% vs. 23.8%), acute kidney injury requiring CRRT (11.4% vs. 38.1%), and secondary revascularization rates (11.9% vs. 24.9%). Postoperative imaging confirmed 100% technical success in limb perfusion restoration, circumventing stent-related complications associated with endovascular-first approaches. 

Mechanistically, concurrent hemodynamic stabilization and distal oxygen delivery mitigate systemic inflammatory cascades and endothelial injury, thereby preserving microvascular integrity. This study further delineates the technical nuances of CPB circuit modification and cannulation site selection to optimize perfusion dynamics. While these outcomes underscore the efficacy of a unified anatomical-physiological repair strategy, this study acknowledges limitations in long-term neurological outcome assessments and calls for multicenter validation. By prioritizing simultaneous aortic repair and perfusion restoration, this study advocates for a paradigm shift in managing malperfusion-complex ATAAD, balancing procedural efficiency with pathophysiological optimization.