Multidisciplinary Treatment of Complicated Aortic Dissection: Combined Endovascular and Surgical Intervention

Abstract

Aortic dissection is the most common catastrophic pathologic process to affect the aorta and its branch vessels. The patient was diagnosed with an acute type III aortic dissection and symptomatic occlusion of the mesenteric, renal, and iliac arteries. The patient was treated with endovascular fenestration and stenting of the iliac and renal arteries followed by open fenestration of the superior mesenteric artery, bowel resection, and cholecystectomy. Duplex ultrasonagraphy demonstrated patency of the mesenteric and iliac vessels and normal size kidneys upon discharge. The combination of traditional surgical and modern endovascular techniques may improve survival of patients with complicated type III aortic dissections.

Get full access to this article

View all access options for this article.

References

1. Wilson SK , Hutchins GM : Aortic dissecting aneurysms: Causative factors in 204 cases. Arch Pathol Lab Med 106:175-180, 1982.

2. Leonard JC , Hasleton PS : Dissecting aortic aneurysms: A clinicopathologic study. Q J Med 48:55-76, 1979.

3. DeBakey ME , McCollum CH , Crawford ES , et al: Dissection and dissecting aneurysms of the aorta: Twenty-year follow-up of 527 patients treated surgically. Surgery 92:1118-1134, 1982.

4. Fann JI , Sarris GE , Mitchell RS , et al: Treatment of patients with aortic dissection presenting with peripheral vascular complications. Ann Surg 212: 705-713, 1990.

5. Miller DC : Surgical management of aortic dissection: Indications, perioperative management, and longterm results. In: Doroghazi RM , Slater EE , eds. Aortic Dissection. New York: McGraw-Hill, 1983, pp 13-34.

6. DeBakey ME , Henly WS , Cooley DA , et al: Surgical management of dissecting aneurysms of the aorta. J Thorac Cardiovasc Surg 49:130-149, 1965.

7. Daily PO , Trueblood W , Stinson EB , et al: Management of acute aortic dissections. Ann Thorac Surg 10:237-247, 1970.

8. Wheat MW Jr , Palmer RJ , Bartley TD , Seelman RC : Treatment of dissecting aneurysms of the aorta without surgery. J Thorac Cardiovasc Surg 50:364-373, 1965.

9. Doroghazi RM , Slater EE , DeSanctis , et al: Long-term survival of patients with treated aortic dissection. J Am Coll Cardiol 3:1026-1034, 1984.

10.

10. Miller DC : The continuing dilemma concerning medical versus surgical management of patients with acute type B dissections. Semin Thorac Cardiovasc Surg 5:33-46, 1993.

11.

11. Miller DC , Stinson EB , Oyer PE , et al: Operative treatment of aortic dissections. J Thorac Cardiovasc Surg 78:365-382, 1979.

12.

12. Cambria RP , Brewster DC , Gertler J , et al: Vascular complications associated with spontaneous aortic dissection. J Vasc Surg 7:199-209, 1988.

13.

13. Walker PJ , Dake MD , Mitchell RS , Miller DC : The use of endovascular techniques for the treatment of complications of aortic dissection. J Vasc Surg 18:1042-1051, 1993.

14.

14. Willimas DM , Lee DY , Hamilton BH , et al: The dissected aorta: Percutaneous treatment of ischemic complications-principles and results. J Vasc Int Rad 8:605-625, 1997.

15.

15. Slonim SM , Nyman UR , Semba CP , et al: True lumen obliteration in complicated aortic dissection: Endovascular treatment. Radiology 201:161-166, 1996.

16.

16. Slonim SM , Nyman U , Semba CP , et al: Aortic dissection: Percutaneous management of ischemic complications with endovascular stents and balloon fenestration. J Vasc Surg 23:241-253, 1996.