| A Case of Acute Type B Dissection
with Limb Ischemia and Severely Compressed True Lumen Cured by
Conservative Therapy |
(Department of Cardiovascular Surgery, Hiroshima
City Asa Hospital, Hiroshima, Japan)
| Tatsuaki Sumiyoshi |
Hiroshi Ishihara |
Naomichi Uchida |
| Sugumichi Ozawa |
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A 73-year-old man suddenly felt
severe back pain. Computed tomography showed acute type B dissection.
The false lumen existed from the distal arch to the right common
femoral artery and was patent. The true lumen was severely compressed
by the false lumen and his right leg was cold. In spite of limb
ischemia, we started conservative therapy because he had severe
airway stenosis due to obesity and obstructive sleep apnea syndrome
(OSAS) and we thought surgical intervention very risky. We thought
OSAS also involved a risk of high blood pressure and started
continuous positive airway pressure. His blood pressure went
down along with the improvement of respiratory conditon. After
12 days from the onset he evacuated bloody stool and gastrointestinal
fiberscopy revealed giant gastric ulcer bleeding. Platelet counts
and prothrombin time began to increase 2 days later. Computed
tomography 14 days after onset showed a patent false lumen and
severely compressed true lumen. Computed tomography 39 days after
onset showed thrombosis of the false lumen and considerable dilatation
of the true lumen. Hypercoagulability after bleeding from gastric
ulcer and treatment of OSAS were important in this successful
conservative therapy.
Jpn. J. Cardiovasc. Surg. 33: 17 -21 (2004) |
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