Surgical strategies in managing organ malperfusion as a complication of aortic dissection

Between December 1978 and March 1994, 48 of 312 patients who underwent surgery for aortic dissection were diagnosed with major vascular complications. There were 18 patients with type A dissection and 30 patients with type B. In 23 patients with acute dissection, the site of vascular obstruction was the abdominal aorta in 12 patients, brachiocephalic artery in 7, iliac artery in 4, left common carotid artery in 3 and thoracic aorta in 2. In 26 patients with chronic dissection, the site of vascular obstruction was the abdominal aorta in 13 patients, brachiocephalic artery in 10, renal artery in 5, iliac artery in 4, superior mesenteric artery in 2, left common carotid artery in 2 and celiac artery in 1. Fifteen patients underwent proximal repair of the aorta during the acute stage, including the ascending aorta in 6 patients, from ascending aorta to arch in 7, arch to descending aorta in 1, thoracoabdominal aorta in 1, and entry closure in 1. In the acute stage, eight patients had palliative surgery, including aortic fenestration in four patients, axillo-femoral bypass in two, cross-over bypass to the iliac or femoral artery in one, bypass to superior mesenteric artery in one, bypass to the renal artery in one, and ileum resection in one. During the chronic phase, seven patients with type B dissection, who had malperfused unilateral renal artery, underwent proximal aortic repair.(ABSTRACT TRUNCATED AT 250 WORDS)