title: Complicated type B aortic dissection causing ischemia in the celiac and inferior mesenteric artery distribution despite patent superior mesenteric artery bypass.
abstract: Mortality rates associated with acute type B aortic dissection (ABAD) complicated by malperfusion remains significant. Optimal management of patients with ABAD is still debatable. We present a case report of a 50-year-old man who was admitted due to ABAD. He was treated medically with his pain resolved and he was discharged on oral antihypertensive medications. One month after initial diagnosis, he was readmitted with abdominal pain, nausea, vomiting, and diarrhea. On imaging, an extension of the aortic dissection into the visceral arteries with occlusion of the celiac and superior mesenteric arteries (SMA) was noted. He underwent thoracic endovascular aortic repair (TEVAR) and bypass grafting to the SMA. Despite the intervention, the patient developed large bowel, liver, and gastric ischemia and underwent bowel resection. He died from multi-organ failure. In selected cases of uncomplicated ABAD, TEVAR should be considered and when TEVAR fails and visceral malperfusion develops, an aggressive revascularization of multiple visceral arteries should be attempted.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, TX, USA Memorial Hermann Heart and Vascular Institute - Texas Medical Center, Houston, TX, USA.
authors.forename: Rana O
authors.initials: RO
authors.lastname: Afifi
authors.affiliation: School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Youwei
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, TX, USA.
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Leake
authors.affiliation: Department of Family and Community Medicine, University of Texas Medical School at Houston, Houston, TX, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Kott
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, TX, USA Memorial Hermann Heart and Vascular Institute - Texas Medical Center, Houston, TX, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Azizzadeh
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, TX, USA Memorial Hermann Heart and Vascular Institute - Texas Medical Center, Houston, TX, USA.
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Estrera
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, TX, USA Memorial Hermann Heart and Vascular Institute - Texas Medical Center, Houston, TX, USA.
authors.forename: Hazim J
authors.initials: HJ
authors.lastname: Safi
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, TX, USA Memorial Hermann Heart and Vascular Institute - Texas Medical Center, Houston, TX, USA Kristofer.CharltonOuw@uth.tmc.edu.
authors.forename: Kristofer M
authors.initials: KM
authors.lastname: Charlton-Ouw
mesh_terms: D000208:Acute Disease; D000284:Administration, Oral; D000784:Aortic Dissection / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D000959:Antihypertensive Agents / Q000008:administration & dosage; D017545:Aortic Aneurysm, Thoracic / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D057510:Endovascular Procedures; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D065666:Mesenteric Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D013152:Splanchnic Circulation; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D014654:Vascular Patency
chemical_list: D000959:Antihypertensive Agents
keywords: Complicated type B aortic dissection; mesenteric artery bypass grafting; thoracic endovascular aortic repair; thoracic endovascular aortic repair in aortic dissection; visceral malperfusion