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Duplex scanner study of carotid artery dissection following surgical treatment of aortic dissection type A
H R Zurbrügg1, F Leupi, P Schüpbach
1Department of Thoracic and Cardiovascular Surgery, University Hospital Berne, Switzerland.
Insights
Persistent false lumen perfusion after aortic dissection repair is common. Duplex ultrasound revealed carotid artery dissection in some patients, but most showed good outcomes, suggesting conservative management may be suitable.
Area of Science:
- Vascular Surgery
- Cardiovascular Imaging
- Neurology
Background:
- Persistent perfusion of the false lumen distal to the graft is a frequent complication after aortic dissection repair.
- Postoperative monitoring of carotid arteries is crucial for assessing outcomes and neurological complications.
Purpose of the Study:
- To evaluate the incidence of residual dissection in the common carotid arteries after surgical repair of acute type A aortic dissection.
- To correlate duplex sonography findings with clinical symptoms in these patients.
Main Methods:
- Duplex sonography of both common carotid arteries was performed in 39 patients postoperatively.
- Patients had an average follow-up of 53 months after receiving either a composite or supracoronary prosthetic vascular graft.
Main Results:
- No residual dissection in the common carotid arteries was observed in 23 patients.
- Nine patients had dissection in both common carotid arteries, and seven had unilateral dissection.
- Nine patients were symptomatic, including transient ischemic attack and stroke; two had corresponding carotid dissections.
Conclusions:
- While carotid artery dissection can occur after aortic dissection repair, the overall prognosis appears favorable.
- The findings suggest that a conservative, nonoperative approach may be appropriate for many patients with these findings.
Abstract:
In patients suffering from aortic dissection, persistent perfusion of the false lumen distal to the implanted graft is frequent. Postoperative follow-up examinations of the carotid arteries of these patients were performed by duplex scanner and correlated with clinical symptoms. Thirty-nine patients who survived the surgical treatment of acute type A aortic dissection had duplex sonography of both common carotid arteries after an average postoperative follow-up of 53 months. In 21 cases a composite graft and in 18 cases a supracoronary prosthetic vascular graft were implanted. No sign of residual dissection of the common carotid arteries was seen in 23 patients; in nine there was a dissection of both common carotid arteries, and seven patients had a unilateral carotid dissection (five right, two left). There were nine symptomatic patients with the following symptoms: transient ischemic attack (four), amaurosis fugax (four), stroke with incomplete recovery (one). Two symptomatic patients had a corresponding dissection. The generally good prognosis of all these patients suggests a conservative nonoperative treatment.