Abstract
An 82-year-old woman was admitted with acute back pain and anemia. Enhanced computed tomography (CT) showed infrarenal an abdominal aortic aneurysm (AAA) with acute type IIIa aortic dissection. As the thoracoabdominal aorta showed severe kinking, the extension of aortic dissection was obstructed due to this rare anatomical feature. Medical therapy was initially performed in the intensive care unit to maintain systemic blood pressure control and improve anemia. Graft replacement of the AAA was then performed without any complications 40 days after the onset of acute aortic dissection. Regular follow up with enhanced CT did not indicate a remarkable change in the type IIIa aortic dissection, which showed a contrast-enhanced pseudolumen. However, sudden death, which we suspected to be due to retrograde aortic dissection, occurred approximately 2 years postoperatively. Surgical intervention for type IIIa aortic chronic dissection with non-thrombosed pseudolumen and severe kinking of the thoracoabdominal aorta can be performed, even in elderly patients.
