2019 Volume 28 Issue 2 Pages 145-148
We report the case of a 49-year-old man who received surgery for a Stanford type A aortic dissection. His height was 176 cm and his weight was 120 kg. He suddenly had strong chest and back pain and was urgently transported to our hospital. We diagnosed Stanford type A acute aortic dissection by enhanced computed tomography (CT) scan and performed an urgent operation. An arterial cannula was placed in the right axillary artery(direct cannulation) and right femoral artery. After extracorporeal circulation had been started, cooling was started. After the rectum temperature was cooled to 27°C, circulatory arrest was induced. We performed total arch replacement with selective cerebral perfusion and open distal anastomosis. After surgery, serum creatine kinase (CK) increased to max 57455 U/L. Serum creatinine (Cr) increased from 1.63 mg/dL (preoperative) to 4.07 mg/dL (peak). Enhanced CT did not show significant ischemic changes in the internal organs or lower limbs. However, the right upper limb was enlarged. We considered that the patient had developed myonephropathic metabolic syndrome from ischemia in the right upper limb, caused by right axillary artery cannulation and perfusion during surgery. We performed blood purification for postoperative oliguria. Acute renal failure improved over the course of time. In the early postoperative stage, the patient could not lift the right upper limb, and had sensation disorder. However, the symptoms improved through rehabilitation and he could return to work.
