Hybrid Approach to Repair Type A Aortic Dissection

Abstract

A Stanford Type A aortic dissection is a life-threatening surgical emergency that requires emergent surgery. The mortality after repair is high especially if the aortic dissection is complicated by visceral or peripheral malperfusion. We describe a case of a male patient who presented with an aortic dissection involving the ascending aorta, aortic arch, descending thoracic aorta, and the abdominal aorta down to the iliac bifurcation. The dissection also involved the visceral and renal arteries with evidence of superior mesenteric artery (SMA) occlusion. Successful outcome was achieved by endovascular stenting of the patient's SMA, followed by a Bentall procedure. To the best of our knowledge this is the first case report in the English literature of SMA stenting followed by a Bentall procedure to treat acute Type A aortic dissection complicated by SMA occlusion.

Key Words

Type A aortic dissection - Bentall procedure - Superior mesenteric artery - Stent graft

• References

• 1 Mehta RH, Suzuki T, Hagan PG, Bossone E, Gilon D, Llovet A. , et al. International Registry of Acute Aortic Dissection (IRAD) Investigators. Predicting death in patients with acute type a aortic dissection. Circulation 2002; 105: 200-206 . 10.1161/hc0202.102246
• 2 Goda M, Imoto K, Suzuki S, Uchida K, Yanagi H, Yasuda S. , et al. Risk analysis for hospital mortality in patients with acute type a aortic dissection. Ann Thorac Surg 2010; 90: 1246-1250 . 10.1016/j.athoracsur.2010.05.069
• 3 Moon MR. Approach to the treatment of aortic dissection. Surg Clin North Am 2009; 89: 869-893 , ix.
• 4 Fann JI, Sarris GE, Mitchell RS, Shumway NE, Stinson EB, Oyer PE. , et al. Treatment of patients with aortic dissection presenting with peripheral vascular complications. Ann Surg 1990; 212: 705-713 . 10.1097/00000658-199012000-00009
• 5 Patel HJ, Williams DM, Dasika NL, Suzuki Y, Deeb GM. Operative delay for peripheral malperfusion syndrome in acute type A aortic dissection: a long-term analysis. J Thorac Cardiovasc Surg 2008; 135: 1288-1295 . 10.1016/j.jtcvs.2008.01.026
• 6 Hirst Jr AE, Johns Jr VJ, Kime Jr SW. Dissecting aneurysm of the aorta: a review of 505 cases. Medicine (Baltimore) 1958; 37: 217-279
• 7 Zierer A, Voeller RK, Hill KE, Kouchoukos NT, Damiano RJ, Moon MR. Aortic enlargement and late reoperation after repair of acute type A aortic dissection. Ann Thorac Surg 2007; 84: 479-487 . 10.1016/j.athoracsur.2007.03.084
• 8 Firstenberg MS, Sai-Sudhakar CB, Sirak JH, Crestanello JA, Sun B. Intestinal ischemia complicating ascending aortic dissection: first things first. Ann Thorac Surg 2007; 84: e8-e9 . 10.1016/j.athoracsur.2007.04.041
• 9 Yilmaz AT, Senay S, Ucak A. Minimally invasive hybrid treatment of acute type I aortic dissection: a single-stage technique without circulatory arrest. Tex Heart Inst J 2012; 39: 405-407
• 10 Jakob H, Tsagakis K. DeBakey type I dissection: when hybrid stent-grafting is indicated?. J Cardiovasc Surg (Torino) 2010; 51: 633-640
• 11 Vedantham S, Picus D, Sanchez LA, Braverman A, Moon MR, Sundt T. , et al. Percutaneous management of ischemic complications in patients with type-B aortic dissection. J Vasc Interv Radiol 2003; 14: 181-194 . 10.1097/01.RVI.0000058320.82956.3f
• 12 Slonim SM, Nyman U, Semba CP, Miller D, Mitchell RS, Dake MD. Aortic dissection: percutaneous management of ischemic complications with endovascular stents and balloon fenestration. J Vasc Surg 1996; 23: 241-251 . 10.1016/S0741-5214(96)70268-9

• References

• 1 Bossone E, Rampoldi V, Nienaber CA, Trimarchi S, Ballotta A, Cooper JV. , et al. Usefulness of pulse deficit to predict in-hospital complications and mortality in patients with acute type A aortic dissection. Am J Cardiol 2002; 89: 851-855 . 10.1016/S0002-9149(02)02198-7
• 2 Cambria RP, Brewster DC, Gertler J, Moncure AC, Gusberg R, Tilson MD. , et al. Vascular complications associated with spontaneous aortic dissection. J Vasc Surg 1988; 7: 199-209 . 10.1067/mva.1988.avs0070199
• 3 Laas J, Heinemann M, Schaefers HJ, Daniel W, Borst HG. Management of thoracoabdominal malperfusion in aortic dissection. Circulation 1991; Nov; 84 (5 Suppl) III20-III24
• 4 Nienaber CA, Eagle KA. Aortic dissection: new frontiers in diagnosis and management: Part II: therapeutic management and follow-up. Circulation 2003; 108: 772-778 . 10.1161/01.CIR.0000087400.48663.19