Aortic Dissection Complicated by Atherosclerotic Aneurysm

(Department of Cardiovascular Surgery, National Hospital Tokyo Disaster Medical Center, Tachikawa, Japan and The Second Department of Surgery, Nihon University School of Medicine*, Tokyo, Japan)

Saeki Tsukamoto Shoji Shindo Masahiro Obana
Kenji Akiyama* Motomi Shiono* Nanao Negishi*
From January 1, 1999 through December 31, 2001, 152 cases of aortic dissection (77 cases of Stanford Type A and 75 Type B) were treated in our department. Among those cases, 25 patients (10 Type A (13.0%) and 15 Type B (20.0%)) were accompanied by atherosclerotic aneurysm. The mean age of onset of those cases was 71.4}9.8 years. Because those patients were older, it is necessary to pay attention to decide on treatment strategy and surgical procedure. In order to prevent atherosclerotic plaque being pumped into the brain vessel, we devised the following surgical procedure and perfusion method of cardiopulmonary bypass as follows; 1. In cases of retrograde perfusion from the femoral artery through the aneurysm, we usually pump the blood more slowly and gently than the antegrade perfusion. 2. We reduce the perfusion pressure after the heart beat changes to ventricular fibrillation. 3. After distal anastomosis of the vascular prosthesis, the blood is pumped from its perfusion branch. An initial tear was located in the spindle-shaped aneurysm in 3 cases (2.0%). Of 11 cases that aortic dissection was in contact with the atherosclerotic aneurysm, 2 cases of saccular shaped aneurysm terminated the dissection. In the 9 cases of spindle shaped aneurysm, however, the dissection involved the aneurysm, suggesting that the effect of aneurysm on the dissection depended on the aneurysmal shape. When the dissection coexists with aneurysm in different portions of the aorta, re-dissection may extend into the aneurysm. Therefore, careful decision making on the timing of surgery is necessary for abdominal aortic aneurysm complicated with aortic dissection, even when treating conservatively.
@Jpn. J. Cardiovasc. Surg. 32F201 -205i2003)