Abstract
A Stanford Type A aortic dissection is a life-threatening surgical emergency that requires emergent surgery. The mortality after repair is high especially if the aortic dissection is complicated by visceral or peripheral malperfusion. We describe a case of a male patient who presented with an aortic dissection involving the ascending aorta, aortic arch, descending thoracic aorta, and the abdominal aorta down to the iliac bifurcation. The dissection also involved the visceral and renal arteries with evidence of superior mesenteric artery (SMA) occlusion. Successful outcome was achieved by endovascular stenting of the patient's SMA, followed by a Bentall procedure. To the best of our knowledge this is the first case report in the English literature of SMA stenting followed by a Bentall procedure to treat acute Type A aortic dissection complicated by SMA occlusion.
Highlights
A Stanford Type A aortic dissection is a lifethreatening surgical emergency that requires emergent surgery
Without intervention in acute Type A aortic dissection, early death occurs in 30% of patients by 24 hours and 93% at 1 month as a result of malperfusion syndromes, or cardiac complications or rupture [6]
Type A aortic dissection is complicated by visceral malperfusion in 16-33% of cases [4,5,6,7]
Summary
A Stanford Type A aortic dissection is a lifethreatening surgical emergency that requires emergent surgery. 25% of aortic dissections have evidence of peripheral malperfusion at presentation [4]. In cases of visceral malperfusion syndrome, involving the superior mesenteric artery (SMA), the operative mortality is significantly increased [5]. Without intervention in acute Type A aortic dissection, early death occurs in 30% of patients by 24 hours and 93% at 1 month as a result of malperfusion syndromes, or cardiac complications or rupture [6]. Type A aortic dissection is complicated by visceral malperfusion in 16-33% of cases [4,5,6,7]. The dissection involved the visceral and renal arteries with evidence of SMA occlusion (Fig. 1C). On arrival to our coronary care unit (CCU) he was hypertensive at 180/110 mm Hg
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