A Case of Surgical Aortic Fenestration for Type B Acute Aortic Dissection with Visceral Malperfusion: Usefulness of Intra-operative Indocyanine Green Fluorescence Imaging

Abstract

Surgical aortic fenestration is known as a treatment of type B acute aortic dissection (TBAAD) with dynamic type malperfusion. Endovascular fenestration is performed more frequently today but surgical fenestration has an advantage in regard to early diagnosis of intestinal ischemic damage and necrosis. A 70-year-old man had abdominal and back pain three days ago. He was diagnosed with TBAAD and transferred to our hospital. Contrast-enhanced CT showed dynamic obstruction of celiac artery and superior mesenteric artery. We planned operation to improve abdominal perfusion. We considered that primary entry closure by TEVAR was high risk for spinal cord ischemia because almost all his intercostal arteries were branched from false lumen. Thus we performed surgical aortic fenestration and confirmed improvement of intestinal blood perfusion by intra-operative indocyanine green fluorescence imaging (ICG-FI). We considered that ICG-FI is a useful method to evaluate intestine blood perfusion when we perform surgical fenestration for TBAAD with visceral malperfusion.