Complicated Acute Aortic Dissection Type B Caused by Femoral Cannulation for Endoscopic Coronary Artery Bypass Surgery

Abstract

Purpose:

To report endovascular treatment of a patient with complicated acute aortic type B dissection caused by cannulation of the femoral artery for endoscopic coronary artery bypass (CAB) surgery.

Case Report:

A 63-year-old man underwent single-vessel CAB surgery facilitated by the Da Vinci surgical system. After the procedure, acute lower limb ischemia led to the discovery of a type B dissection from the left subclavian artery to the iliac arteries. The subclavian artery was also dissected, with only minimal flow in the left mammary artery. The visceral and renal vessels originated from the false lumen and were not perfused. Emergent stent-graft placement was undertaken to close the entry tear and re-establish perfusion of the lower extremity as well as visceral and renal organs. Additional stent-grafts were placed in the dissected left subclavian artery to perfuse the left internal mammary bypass and in the inferior mesenteric artery, which arose from the false lumen. Six months after operation, the patient is well.

Conclusions:

Acute iatrogenic aortic dissection secondary to endoscopic CAB surgery can be treated emergently to restore distal perfusion to vital organs.