Surgical strategies for organ malperfusions in acute type B aortic dissection.
This study is retrospectively to evaluate strategies for organ malperfusion on the view point of two mechanisms (true lumen collapse in the aorta=Ao type, or branch dissection=Br type) in acute type B aortic dissection. There were 16 of Ao type and 4 of Br type in 20 patients with organ malperfusion. In Ao type, we performed entry closure in 12 patients, surgical bypass grafting in two to superior mesenteric artery (SMA) in one and femoral artery in two, and surgical fenestration in two. In Br type, we performed interventional non-covered stenting to the orifice of visceral arteries in two patients, surgical bypass to SMA with ileum resection in one, and surgical bypass to SAM and renal arteries in one. Five patients in 16 of Ao type died within 30 days that had two multiple organ failure after entry closure, one aortic injury during endovascular stent graft repair, two more multiple organ failure after femoral bypass, however, all four patients in Br type were rescued. Central aortic operation to true lumen collapse with entry closure for Ao type ischemia and organ reperfusion with extra-anatomical bypass or non-covered stent to ischemic arteries for Br type ischemia should be performed before catastrophic status.
Uchida
Naomichi
N
Division of Cardiovascular Surgery, Hiroshima-city Asa General Hospital, Hiroshima, Japan. uchidacvs@yahoo.co.jp
Shibamura
Hidenori
H
Katayama
Akira
A
Aishin
Keishi
K
Sutoh
Miwa
M
Kuraoka
Masatsugu
M
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008297:Male; D017538:Mesenteric Artery, Superior / Q000601:surgery; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality