[Successful Two-stage Surgical Treatment of Acute Type A Aortic Dissection with Mesenteric Ischemia]

We report the case of a patient with acute type A aortic dissection associated with mesenteric ischemia who underwent superior mesenteric artery (SMA) bypass grafting prior to aortic repair, and obtained a satisfactory outcome. A 70-year-old man presented with sudden chest pain. Computed tomography( CT) revealed acute type A aortic dissection with occlusion of the celiac artery and severe stenosis of the SMA. The false lumen, extending from the aortic root to the inferior mesenteric artery, was completely thrombosed except around the entry at the proximal aortic arch. Mesenteric ischemia was diagnosed. In light of the stable hemodynamics and ongoing mesenteric ischemia, a right common iliac artery-to-SMA bypass was performed, primarily to relieve mesenteric ischemia. At 5 days postoperatively, hemodynamics gradually became unstable. CT demonstrated further dilatation of the ascending aorta, growth of pericardial effusion, and recanalization of the thrombosed false lumen. We performed emergency ascending aorta and hemiarch replacement. He was discharged in a good state, 34 days after onset. Two-stage surgical treatment should be considered as alternative management in patients with mesenteric ischemia.