[Acute type A aortic dissection associated with intestinal necrosis].

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.