| Abdominal Aortic Aneurysm Accompanied
by Aortic Dissection |
(Department of Cardiovascular Surgery, Surugadai
Nihon University Hospital, Tokyo, Japan, Department of Cardiovascular
Surgery, National Hospital Tokyo Disaster Medical Center*, Tachikawa,
Japan and The Second Department of Surgery, Nihon University School
of Medicine**, Tokyo, Japan)
| Saeki Tsukamoto |
Yukihiko Orime |
Shoji Shindo* |
| Shinsuke Choh |
Masahiro Obana** |
Kenji Akiyama** |
| Motomi Shiono** |
Nanao Negishi** |
|
|
Three cases of aortic dissection
involving abdominal aortic aneurysms are reported. Two of the
3 cases died from intestinal necrosis. In one of them, the abdominal
aortic aneurysm ruptured following aortic dissection. Fenestration
was not performed at the proximal anastomosis in the operation,
and it is thought that this resulted in occurrence of intestinal
necrosis due to superior mesenteric artery obstruction. In the
other non-survivor, aortic fenestration and graft replacement
were performed. However, he died from descending\sigmoid colon
necrosis due to internal iliac artery obstruction. An autopsy
demonstrated no problem that with the graft anastomosis. The
successful case of aortic fenestration and graft replacement
had no postoperative complications. Since the aortic wall is
fragile in acute aortic dissection, it is advisable that operation
be conducted 1 month after the onset except in cases of aortic
rupture and malperfusion syndrome. Fenestration, which is usually
safe in chronic dissection, should be performed and it is desirable
to fenestrate the aortic wall if possible even in acute dissection.
@Jpn. J. Cardiovasc. Surg. 33: 162-165 (2004) |
|
