Surgical experiences in acute spontaneous dissection of the infrarenal abdominal aorta.
OBJECTIVE
Spontaneous dissection of the abdominal aorta should be considered as a vascular surgical emergency. We report here our experience with this rare pathology.


METHODS
At our hospital, we operated on 200 patients for abdominal aortic aneurysm over a 4-year period, and aortic dissection was the underlying pathology in eight of them. Diagnosis was based on history, imaging study findings and visualization at surgery.


RESULTS
The mean size of the aorta at the time of diagnosis was 5.5 +/- 0.4 cm. Aortic dissection was complicated by acute ischemia of lower limb and paraplegia in 1 patient and four patients were admitted to hospital with severe abdominal and back pain. Two patients with contained rupture were admitted with hemodynamic collapse and shock. One of the patients who presented with abdominal pain experienced also sudden onset paraplegia. The diagnosis of dissecting abdominal aortic aneurysm was established incidentally in the remaining 2 patients. All patients were treated using open techniques with paramedian transperitoneal incision. We performed aorto-bifemoral bypass operation procedure in all patients; there was no post-operative mortality in our series. One patient had to be reoperated because of bleeding during early postoperative period. One patient required transient dialysis at early postoperative period because of transient rise of serum creatinine level.


CONCLUSIONS
The surgical treatment of spontaneous abdominal aortic dissection is usually associated with low morbidity and mortality rates. However, the clinical form of presentation of acute abdominal aortic dissection is usually nonspecific, and diagnosis requires a high index of suspicion.
Kalko
Yusuf
Y
Cardiovascular Surgery Service, Bezm-i Alem Vakif Gureba Hospital, Istanbul, Turkey. ykalko@mynet.com
Kafa
Ulkü
U
Başaran
Murat
M
Köşker
Taylan
T
Ozçalişkan
Ozerdem
O
Yücel
Erdal
E
Aydin
Unal
U
Yaşar
Tahsin
T
D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D001012:Aorta, Abdominal / Q000473:pathology / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D003404:Creatinine / Q000097:blood; D004638:Emergency Treatment; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000401:mortality
D003404:Creatinine