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Surgical treatment for acute aortic dissection and coexistent degenerative aortic aneurysm. Report of three cases
S Aoyagi1, H Akashi, Y Hanamoto
1Second Department of Surgery, Kurume University School of Medicine, Japan.
Insights
Acute aortic dissection with degenerative aortic aneurysm is rare. Prompt surgery and digital subtraction angiography (DSA) are crucial for managing this high-rupture-risk condition.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Diagnostic Imaging
Background:
- Degenerative atherosclerotic aortic aneurysms can predispose individuals to aortic dissection.
- Acute aortic dissection (DeBakey type III-b) in the presence of a preexistent degenerative aortic aneurysm is an uncommon clinical scenario.
Observation:
- Three cases of DeBakey type III-b acute aortic dissection in patients with degenerative aortic aneurysms are presented.
- Dissection originated from the aneurysm in two cases; in one case, dissection and aneurysm were in different aortic segments.
Findings:
- The coexistence of acute aortic dissection and degenerative aortic aneurysm significantly increases the risk of aortic rupture compared to dissection alone.
- Digital subtraction angiography (DSA) proved more effective than other noninvasive methods for diagnosis and surgical planning.
Implications:
- A prompt and aggressive surgical strategy is essential for patients with concurrent acute aortic dissection and degenerative aortic aneurysm to mitigate rupture risk.
- DSA is a valuable tool for accurate diagnosis and guiding treatment decisions in these complex cases.
Abstract:
Acute aortic dissection occurring in an aorta previously afflicted with degenerative, atherosclerotic is unusual. We report three cases with acute aortic dissection (DeBakey type III-b) occurring in an aorta which had a preexistent degenerative aortic aneurysm. Two of the three patients had acute aortic dissection originating from the distal end of the degenerative aneurysm, and the remaining one had the acute aortic dissection and degenerative aneurysm at different segments of the aorta. Since the risk of rupture is likely to be much higher in the patients with coexistence of acute aortic dissection and degenerative aortic aneurysm, compared with patients with DeBakey type III acute aortic dissection alone, we believe that a prompt and aggressive surgical approach is essential to prevent rupture, and that digital subtraction angiography (DSA) is more helpful in making a correct diagnosis and in helping to decide surgical procedures and supportive methods than other noninvasive diagnostic procedures.