Delayed Intestinal Ischemia after Surgery for Type A Acute Aortic Dissection.

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Gastroenterology

Background:

• Type A acute aortic dissection requires urgent surgical intervention, often involving aortic arch replacement.
• Visceral artery complications, including ischemia, can occur due to aortic dissection or surgical manipulation.

Observation:

• A patient undergoing total arch replacement for type A acute aortic dissection developed delayed intestinal ischemia on postoperative day 12.
• Initial CT angiography showed celiac trunk occlusion and dissection into the superior mesenteric artery, but no visceral malperfusion was detected intraoperatively.
• The patient presented with paralytic ileus and subsequent CT angiography revealed new superior mesenteric artery stenosis due to a thrombosed false lumen.

Findings:

• Delayed intestinal ischemia occurred post-aortic arch replacement, presenting as paralytic ileus without elevated lactate.
• Superior mesenteric artery stenosis, caused by a thrombosed false lumen, was identified as the cause of ischemia.
• Endovascular treatment, including stent implantation, effectively resolved the superior mesenteric artery stenosis and intestinal ischemia.

Implications:

• This case underscores the importance of vigilant monitoring for delayed visceral complications after aortic dissection repair.
• Endovascular techniques offer a viable and effective treatment option for managing delayed intestinal ischemia in this patient population.
• Further research into the mechanisms and optimal management strategies for post-aortic dissection repair visceral ischemia is warranted.