title: Haemolytic anaemia resulting from the surgical repair of acute type A aortic dissection.
abstract: OBJECTIVE
  Haemolytic anaemia after acute aortic dissection surgery is extremely rare. We report 4 cases of haemolytic anaemia with different aetiologies.
  
  
  METHODS
  Four patients underwent emergency operation for acute type A aortic dissection and subsequently developed haemolytic anaemia.
  
  
  RESULTS
  Case 1: a 41-year old man underwent hemiarch replacement. We performed total arch replacement 3 years postoperatively, which revealed that haemolytic anaemia was induced by proximal anastomotic stenosis caused by inverted internal felt strip. Case 2: a 28-year old man diagnosed with Marfan syndrome underwent total arch replacement. Five months postoperatively, we noted severe stenosis at the previous distal anastomotic site, which caused the haemolytic anaemia, and performed descending thoracic aortic replacement for a residual dissecting aneurysm. Case 3: a 49-year old man underwent hemiarch replacement. Three years postoperatively, we performed total arch replacement for a residual dissecting aortic arch aneurysm and repaired a kinked graft responsible for haemolytic anaemia. Case 4: a 42-year old man underwent total arch replacement. Eighteen months later, we performed descending thoracic aortic replacement. We repaired a portion of the ascending aorta as haemolityc anaemia was induced by kinking of a total arch replacement redundant graft.
  
  
  CONCLUSIONS
  All the haemolityc anaemia patients were successfully released after surgical reintervention.
authors.affiliation: Department of Aortic Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Sekine
authors.forename: Shin
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Takuya
authors.initials: T
authors.lastname: Fujikawa
authors.forename: Susumu
authors.initials: S
authors.lastname: Oshima
authors.forename: Makoto
authors.initials: M
authors.lastname: Ono
authors.forename: Shiro
authors.initials: S
authors.lastname: Sasaguri
mesh_terms: D000208:Acute Disease; D000328:Adult; D000743:Anemia, Hemolytic / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D004630:Emergencies; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Acute aortic dissection; Haemolytic anaemia; Inverted internal felt strip; Kinked graft; Reoperation