Abstract
In cases with malperfusion due to acute aortic dissection, the mortality rate is high if intestinal ischemia occurs. We herein report 2 cases in which a successful outcome was obtained by carrying out iliac artery to superior mesenteric artery bypass surgery for intestinal ischemia due to acute aortic dissection. Case 1: A 30-year-old man had occlusion of the left common iliac artery due to type B acute aortic dissection upon observed on computed tomography (CT). Although the dissociation of the superior mesenteric artery (SMA) was extended, no occlusion was observed. However, a peritoneal irritation occurred 3 days following femoro-femoral artery bypass surgery and SMA occlusion was observed on CT, and therefore an emergency laparotomy was performed. The entire small intestine demonstrated a pale color, and therefore a right common iliac artery-SMA bypass surgery was performed using the greater saphenous vein. Resection of the necrotic area of the small bowel was carried out in 2 stages, leading to the successful recovery of the patient. Case 2 was a 63-year-old man who presented with type A acute aortic dissection which was associated with cardiac tamponade on CT, and although the dissociation of the SMA root was extended, no occlusion was observed. However, abdominal pain occurred 15 days after an emergency surgical replacement of the ascending aorta, true lumen narrowing of the SMA was observed on CT, and the condition subsequently became aggravated. However, the patient recovered thereafter due to successful left external iliac artery-SMA bypass surgery.
