Abdominal Aortic Aneurysm Accompanied by Aortic Dissection

(Department of Cardiovascular Surgery, Surugadai Nihon University Hospital, Tokyo, Japan, 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 Yukihiko Orime Shoji Shindo*
Shinsuke Choh Masahiro Obana** Kenji Akiyama**
Motomi Shiono** Nanao Negishi**
Three cases of aortic dissection involving abdominal aortic aneurysms are reported. Two of the 3 cases died from intestinal necrosis. In one of them, the abdominal aortic aneurysm ruptured following aortic dissection. Fenestration was not performed at the proximal anastomosis in the operation, and it is thought that this resulted in occurrence of intestinal necrosis due to superior mesenteric artery obstruction. In the other non-survivor, aortic fenestration and graft replacement were performed. However, he died from descending\sigmoid colon necrosis due to internal iliac artery obstruction. An autopsy demonstrated no problem that with the graft anastomosis. The successful case of aortic fenestration and graft replacement had no postoperative complications. Since the aortic wall is fragile in acute aortic dissection, it is advisable that operation be conducted 1 month after the onset except in cases of aortic rupture and malperfusion syndrome. Fenestration, which is usually safe in chronic dissection, should be performed and it is desirable to fenestrate the aortic wall if possible even in acute dissection.
@Jpn. J. Cardiovasc. Surg. 33: 162-165 (2004)