Surgical Fenestration for Acute Type A Aortic Dissection with Visceral and Lower Limb Ischemia and Paraplegia

Kiyotaka Suzuki＊	Keiji Uchida＊	Tomoyuki Minami＊
Tomoki Cho＊	Yusuke Matsuki＊	Hiroko Nemoto＊
Yoshiyuki Kobayashi＊	Atsushi Matsumoto＊	Munetaka Masuda＊

（Cardiovascular Center, Yokohama City University Medical Center＊, Yokohama, Japan）

A 70-year-old man developed sudden chest, back, abdominal, and lower extremity pain, and clinical findings and contrast-enhanced computed tomography（CT）revealed acute type A aortic dissection with visceral, lower leg, and spinal cord ischemia. The false lumen of the ascending aorta was thrombosed, and the entry site was observed in the proximal descending aorta without a re-entry tear. The true lumen of the aorta extended from the descending thoracic aorta to the abdominal aorta and was significantly narrowed. The celiac and superior mesenteric arteries received blood supply from the narrowed true lumen and several intercostal arteries from the partially thrombosed false lumen. Central repair for resection of the entry tear could impair blood flow through the false lumen and the intercostal arteries;therefore, we performed open aortic fenestration. Postoperative contrast-enhanced CT revealed that the width of the true lumen and blood flow through the false lumen of the descending aorta were adequately improved with resolution of the patient’s clinical symptoms. The patient’s postoperative course was uneventful, and he was discharged on postoperative day 30. Emergency central repair has been reported as a first-line approach for acute type A aortic dissections;however, surgical fenestration may be useful for patients who receive conservative treatment for the ascending aorta and present with multiple sites of malperfusion that causes spinal cord ischemia.

 

Jpn. J. Cardiovasc. Surg. 50:405-409（2021）

Keywords：acute aortic dissection;surgical fenestration;multiple malperfusion