Preoperative fenestration for type A acute aortic dissection with mesenteric malperfusion.

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Gastrointestinal Surgery

Background:

• Acute type A aortic dissection is a life-threatening condition requiring prompt surgical intervention.
• Extension of the intimal flap into branch arteries, such as the mesenteric artery, can lead to complex presentations.
• Mesenteric ischemia significantly increases surgical risk and may necessitate delaying definitive aortic repair.

Observation:

• A 71-year-old male presented with acute type A aortic dissection and concurrent mesenteric ischemia.
• Severe abdominal symptoms from mesenteric ischemia precluded immediate ascending aorta repair.
• Preoperative percutaneous fenestration was successfully performed to manage the mesenteric ischemia.

Findings:

• Ascending aorta replacement was successfully performed 6 days after initial presentation.
• The patient developed transverse colon stenosis postoperatively, a complication of preoperative ischemia.
• The patient achieved normal intestinal transit and was discharged 72 days later.

Implications:

• Percutaneous fenestration can be a valuable temporizing measure in complex aortic dissections with visceral compromise.
• Careful postoperative monitoring is crucial for managing complications like ischemic colitis following aortic dissection repair.
• This case highlights the challenges and successful management of a rare presentation of type A aortic dissection with mesenteric ischemia.