Complicated acute aortic dissection type B caused by femoral cannulation for endoscopic coronary artery bypass...

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Vascular Surgery

Background:

• Coronary artery bypass (CAB) surgery, particularly minimally invasive endoscopic techniques, carries potential risks.
• Iatrogenic aortic dissection is a rare but serious complication that can arise during vascular access procedures.

Observation:

• A 63-year-old male developed acute aortic type B dissection extending from the left subclavian to iliac arteries after femoral artery cannulation for endoscopic CAB surgery.
• The dissection compromised flow to lower extremities and critical visceral and renal arteries, originating from the false lumen.
• The left subclavian artery was also dissected, impacting flow to the left internal mammary artery bypass.

Findings:

• Emergent endovascular stent-graft placement was performed to seal the primary entry tear.
• Stent-grafts were strategically placed to re-establish perfusion to the lower extremities, visceral, and renal organs.
• Additional stent-grafts addressed the left subclavian artery dissection and the inferior mesenteric artery originating from the false lumen.

Implications:

• Endovascular techniques offer a viable and emergent treatment option for complex iatrogenic aortic dissections.
• Prompt intervention can successfully restore perfusion to vital organs and prevent limb ischemia in these challenging cases.
• This case highlights the importance of vigilance and preparedness for managing vascular complications during minimally invasive cardiac surgery.