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[Acute type A aortic dissection associated with intestinal necrosis]

Takashi Kunihara1, Y Matsui, T Murashita

  • 1Department of Cardiovascular Surgery, Hokkaido University School of Medicine, Sapporo, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery
|May 11, 2005
PubMed

Insights

This case study details a 79-year-old man with acute type A aortic dissection affecting the celiac artery (CA) and superior mesenteric artery (SMA). Surgical repair involved aortic valve replacement and bypass grafting, with partial bowel resection.

Area of Science:

  • Cardiovascular Surgery
  • Gastrointestinal Surgery
  • Vascular Surgery

Background:

  • Acute type A aortic dissection (AADA) is a life-threatening condition often requiring complex surgical intervention.
  • Occlusion of major visceral arteries, such as the celiac artery (CA) and superior mesenteric artery (SMA), can complicate AADA management.
  • Previous abdominal aortic aneurysm repair may influence the surgical approach and outcomes in patients with recurrent aortic dissection.

Observation:

  • A 79-year-old male with a history of Y-graft abdominal aortic aneurysm repair presented with recurrent, thrombosed type A acute aortic dissection.
  • The dissection was associated with acute occlusion of the celiac artery (CA) and superior mesenteric artery (SMA).

Findings:

  • The patient underwent successful aortic valve and ascending aorta replacement combined with CA and SMA bypass grafting.
  • Despite successful revascularization, residual intestinal necrosis in the ileum and cecum necessitated partial resection.
  • The patient was discharged 11 months postoperatively with no neurological deficits.

Implications:

  • This case highlights the feasibility of combined aortic and visceral artery bypass grafting in managing complex AADA with mesenteric ischemia.
  • Aggressive surgical management can achieve favorable outcomes even in patients with extensive aortic pathology and visceral compromise.
  • Early recognition and management of visceral artery complications are crucial for improving survival in acute aortic dissection.

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