Total descending thoracic and abdominal aorta grafting in type III aortic dissection with aneurysm

Single-stage complete replacement of the descending thoracic aorta and the abdominal aorta is a surgical challenge. A 65-year-old man developed acute DeBakey type IIIB aortic dissection and was treated medically. The affected aorta dilated progressively, reaching a maximal diameter of 7 cm 2 years later. Computed tomography revealed a Crawford type II thoracoabdominal aortic aneurysm and an additional infrarenal abdominal aortic aneurysm below the dissected aorta. The descending thoracic aorta and the abdominal aorta were completely replaced with a Hemashield graft under deep hypothermic circulatory arrest. The postoperative course was complicated with transient left hemiparesis and upper gastrointestinal bleeding which were successfully treated by transarterial embolization. The results of this case indicate that complete replacement of the descending thoracic and abdominal aorta can adequately and safely treat type III aortic dissection.