Abstract
A 45-year-old man had received hemodialysis (HD) three times a week for fourteen years. Suddenly, the patient experienced severe left chest pain while having a bowel movement on the morning of January 26, 1994. He was taken to the hospital where he usually received HD, and HD was started. Though his blood pressure was not remarkably low the pulse in his bilateral femoral arteries and dorsalis pedis arteries were very weak. A dissecting aneurysm was suspected and he was transferred to our hospital. CT scan and trans-esophageal echography revealed a DeBakey type IIIb dissecting aneurysm. We controlled only his blood pressure during preoperative treatment. On the same day, he underwent an emergent graft inclusion procedure for a dissecting aneurysm of the thoracic descending aorta and left femoro-right femoral bypass. During surgery, he received hemodialysis with extracorporeal circulation for oxygenation. After surgery, he remained in the ICU for a few days because he had lost consciousness, but his condition improved daily, and approximately one week after surgery he was receiving routine continuous HD treatment.
The treatment for dissecting aneurysm of the aorta in chronic HD patients is discussed along with several other reports. This case is very valuable for comparison with other cases, because this is the only surviving patient who has undergone emergency surgery.
