Surgical treatment of spontaneous isolated middle aortic dissection

Abstract

To explore the diagnosis and treatment of spontaneous isolated middle aortic dissection (SIMAD). The clinical data of 7 SIMAD patients admitted into our hospital between January 2007 and June 2011 were retrospectively analyzed. There were 3 males and 4 females with an average age of 53 years old. Five patients had an acute onset. According to the original tear location and flow of celiac artery, 6 patients received endovascular repair and another patient underwent abdominal aorta-bilateral-femoral artery bypass with artificial graft. All cases were successfully treated. Six patients recovered well from the procedures. One patient suffered acute coronary artery syndrome at Day 2 after endovascular treatment. After transferral into cardiology unit, emergency percutaneous transluminal coronary angioplasty was performed with a satisfactory outcome. The postoperative examinations of CTA (computed tomography angiography) of all patients demonstrated that the false lumen of dissection was basically thrombolized without endoleak or stent migration. Vascular surgeons should pay more attention to SIMAD with the potentials of rupture and aneurysm. Endovascular graft exclusion may be a first-line therapy as long as the anatomical conditions allow. However, longer follow-up and further evaluations should be performed to determine the long-term benefits.