Critical Malperfusion Caused by Central Aortic Repair for Acute Aortic Dissection: A Case Report

Abstract

We encountered a case of hepatic malperfusion resulting from central repair for Stanford type A acute aortic dissection (AAD). A 78-year-old woman had AAD, for which ascending aortic repair was performed. Hepatic malperfusion developed 3 days postoperatively. The superior mesenteric and celiac arteries were occluded by a false lumen (FL). We believed that the surgery caused a change in the blood flow in FL. Percutaneous transluminal angioplasty and stenting of the superior mesenteric artery were performed, and the patient’s condition improved. Thus, intervention for the branched artery should be performed prior to central repair, depending on the type of malperfusion.

Surgical choice for the treatment of partial intestinal ischemic necrosis caused by acute type a aortic dissection combined with malperfusion of superior mesenteric artery

“…Additionally, the false lumen of the branch vessel intima is perfused with blood flow [20]. An AAD can cause mesenteric ischemia by two mechanisms: first, by occluded or narrowed SMA arteries by directly progressive dissection into the vessel, and second, by occlusion of the vessel origin by a dissection flap within the aortic lumen [21,22], known as aortic type and branch type [23]. For cases of aortic malperfusion with dynamic obstruction, central aortic surgery or fenestration is recommended, where there is an obstruction at the origin of the vessel due to a dissecting flap within the aortic lumen.…”