PDF herunterladen
CC BY-NC-ND 4.0 · Aorta (Stamford) 2013; 01(02): 126-130
DOI: 10.12945/j.aorta.2013.12.008
Case Report

Simultaneous Surgical Treatment of Type B Dissection Complicated With Visceral Malperfusion and Abdominal Aortic Aneurysm

Role of Aortic Fenestration
Gianfranco Filippone
1   Division of Vascular and Endovascular Surgery, Palermo, Italy
,
Gabriele Ferro
1   Division of Vascular and Endovascular Surgery, Palermo, Italy
,
Cristiana Duranti
2   Section of Radiology, Ospedale Civico e Benfratelli, Palermo, Italy
,
Gaetano La Barbera
1   Division of Vascular and Endovascular Surgery, Palermo, Italy
,
Francesco Talarico
1   Division of Vascular and Endovascular Surgery, Palermo, Italy
› Institutsangaben
› Weitere Informationen
   Lizenzen und Reprints

Abstract

Aortic dissection occurs in about 5% of patients with coexistent abdominal aortic aneurysm (AAA); combined type B dissection complicated with visceral malperfusion and AAA is an uncommon aortic emergency and patients presenting with complications of thoracic aortic dissection have a dismal prognosis related to difficulties in treatment strategies. Despite tremendous improvement of endovascular techniques, surgical aortic fenestration represents a quick, safe, and effective procedure able to restore flow in an otherwise malperfused aorta. This procedure has to be kept in mind because subsets of patients cannot be treated conventionally due to either prohibitive risk of aortic replacement, anatomic contraindication, or limitations of percutaneous procedures. Herein we report a case of a patient presenting with type B aortic dissection complicated by visceral malperfusion and AAA which was successfully treated simultaneously by open AAA repair and surgical fenestration. We focus on the mechanism of malperfusion and on the role of surgical fenestration.

Key Words

Aortic dissection - Visceral malperfusion - Fenestration


Publikationsverlauf

Eingereicht: 10. November 2012

Angenommen: 09. März 2013

Publikationsdatum:
28. September 2018 (online)

© 2013. Thieme. All rights reserved.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

  • References

  • 1 Cambria RP, Brewster DC, Moncure AC, Steinberg FL, Abbot WM. Spontaneous aortic dissection in the presence of coexistent or previously repaired atherosclerotic aortic aneurysm. Ann Surg 1988; 208: 619-624
    CrossrefPubMedGoogle Scholar
  • 2 Uchida N, Shibamura H, Katayama A, Aishin K, Sutoh M, Kuraoka M. Surgical strategies for organ malperfusions in acute type B aortic dissection. Interac Cardiovasc Thorac Surg 2009; 8: 7678 10.1510/icvts.2008.186247
    PubMedGoogle Scholar
  • 3 Roberts CS, Roberts WC. Combined thoracic aortic dissection and abdominal aortic fusiform aneurysm. Ann Thorac Surg 1991; 52: 537-540 10.1016/0003–4975(91)90920-L
    CrossrefPubMedGoogle Scholar
  • 4 Fattori R, Botta L, Lovato L, Biagini E, Russo V, Casadei A. et al. Malperfusion syndrome in type B dissection: role of the endovascular procedures. Acta Chir Belg 2008; 108: 192-197
    PubMedGoogle Scholar
  • 5 Panneton JM, The SH, Cherry KJ, Hofer JM, Gloviczki P, Andrews JC. et al. Aortic fenestration for acute or chronic aortic dissection: An uncommon but effective procedure. J Vasc Surg 2000; 32: 711-727 10.1067/mva.2000
    PubMedGoogle Scholar
  • 6 Pradhan S, Elefteriades JA, Sumpio BE. Utility of the aortic fenestration technique in the management of acute aortic dissections. Ann Thorac Cardiovasc Surg 2007; 13: 296-300
    PubMedGoogle Scholar
  • 7 Hartnell GG, Gates J. Aortic fenestration: A why, when and how to guide. Radiographics 2005; 25: 175-189 10.1148/rg.251045078
    PubMedGoogle Scholar
  • 8 Trimarchi S, Jonker FHW, Muhs BE, Grassi V, Righini P, Upchurch GR. et al. Long- term outcomes of surgical fenestration for complicated acute type B aortic dissection. J Vasc Surg 2010; 52: 261-266 10.1016/j.jvs.2010.02.292
    PubMedGoogle Scholar