A Surgical Case of Type B Aortic Dissection with Concomitant Distal Aortic Arch Aneurysm

(Department of Cardiovascular Surgery, NTT East Corporation Sapporo Hospital, Sapporo, Japan)

Ko Takigami Masatoshi Motohashi Akira Adachi
Keishu Yasuda
A 70-year-old man was given emergency admission with severe back pain. Computer tomography revealed type-B acute aortic dissection with a distal aortic arch aneurysm which was 69mm in diameter. The dissection extended from the distal portion of the aneurysm to right external iliac artery, and the false lumen was patent. The right renal artery arose from the false lumen. He was treated conservatively according to the guidelines of AHA, and later we performed total arch replacement electively for the aortic arch aneurysm. Distal anastomosis was applied using the elephant trunk method for reconstruction of only the true lumen. Postoperative computer tomography showed the false lumen was closed in the descending thoracic aorta, but patent below the level of the celiac artery. He was discharged without any complications. Cases of acute aortic dissection coexisting with atherosclerotic thoracic aortic aneurysm are rare. However, with the increase of the elderly population, vascular diseases will become more complicated. Strategy for therapy and operation should be considered carefully especially in such cases with multiple vascular diseases.
@Jpn. J. Cardiovasc. Surg. 36: 162-165 (2007)