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Acute type A aortic dissection surgery impeded by substernal colon interposition.

Maximilian Vondran1, Farhad Bakhtiary2, Michael Andrew Borger2

  • 1Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany maxmilian.vondran@gmx.de.

Interactive Cardiovascular and Thoracic Surgery
|October 15, 2014
PubMed
Summary

This case report details the first successful surgical repair of acute aortic dissection (Stanford type A) in a patient with a history of esophageal resection and a colonic graft adhered to the sternum.

Keywords:
Aorta/aorticAortic archAortic dissectionAortic operationOesophageal biology/pathologyOesophageal injury/perforation

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Vascular Surgery

Background:

  • Acute aortic dissection (Stanford type A) is a life-threatening condition requiring prompt surgical intervention.
  • Patients with prior thoracic surgery, such as esophageal resection with colonic interposition, present unique challenges for aortic repair.
  • Adherence of the colonic graft to the sternum can complicate surgical access and increase operative risk.

Observation:

  • A 54-year-old female patient with a history of esophageal resection and substernal colon interposition presented with acute aortic dissection, Stanford type A.
  • Preoperative computed tomography revealed the aortic dissection and demonstrated the colonic graft's adherence to the sternum.

Findings:

  • The patient underwent successful surgical treatment for the aortic dissection despite the complex anatomical situation.
  • This represents the first reported successful surgical management of aortic dissection in a patient with this specific surgical history and graft adherence.

Implications:

  • This case highlights the feasibility of surgical aortic dissection repair even in highly complex, previously operated patients.
  • It underscores the importance of detailed preoperative imaging to identify potential challenges like graft adherence.
  • Successful management in such cases expands treatment options for patients with complex cardiovascular and gastrointestinal surgical histories.