Abstract
Aortic dissections can occur during aortic surgery, and their occurrence is due to a variety of contributing factors such as acute onset and surgical intervention. We report a 59-year-old woman who was admitted with a sudden onset of epigastralgia. The diagnosis, based on a thoracic CT scan was aortic dissection of acute thrombotic-type (Stanford A, DeBakey II) and immediate surgical intervention was required.
No differences in preoperative arm or leg blood pressure were observed on either side of the body, no anisopiesis was detected, and there was no difference in the bilateral pulse, which was good in the brachial and femoral arteries on both sides. Cardiopulmonary bypass was performed through the right femoral artery, using the bilateral superior venal caval with inferior vena cava cannulation and femoral perfusion. We cross-clamped the ascending aorta at the normal distal site, and after resection of an ascending aortic tear, we replaced the ascending aorta with a vascular prosthesis measuring 24 mm in diameter. Perioperatively, the hemodynamics of the patient remained stable, and no increase in arterial blood flow impedance, decrease in peripheral arterial pressure, or decrease in venous drainage was seen. Her blood biochemistry did not reveal any problems and the urine volume remained stable.
Postoperatively, impaired hepatic and renal function was found, and thoracoabdominal CT findings led to a diagnosis of DeBakey type III dissection. In this case, it occurred during ascending aortic replacement surgery for a DeBakey type II dissection, suggesting the possible involvement of retrograde femoral arterial blood flow in aortic dissection. We report a rare case in which the symptoms abated with conservative treatment.
