A Successful Case of Open Stent-Grafting for an Impending Ruptured Acute Type B Aortic Dissection

(Department of Cardiovascular Surgery, Osaka Mishima Emergency and Critical Care Medical Center, Takatsuki, Japan)

Kan Hamori Masayoshi Nishimoto Keiichi Furubayashi
Hitoshi Fukumoto
A 70-year-old man was admitted suffering from chest and back pain. He was assessed by enhanced computed tomography (eCT) and a thrombosed acute DeBakey type IIIb aortic dissection with an ulcer like projection (ULP) was diagnosed and treated medically. Five days later, he complained suddenly of dyspnea and was diagnosed by eCT as having a pulmonary thromboembolism. Anticoagulant therapy was started reluctantly. The patient's symptoms improved, however, 16 days later he complained of severe chest and back pain. Enhanced CT showed enlargement of the ULP, which was diagnosed as an impending aortic rupture. Open stent-grafting was selected as a less-invasive treatment method. A stent-graft was introduced into the descending aorta via the transected aortic arch and the entry of the ULP was closed. Postoperative course was smooth and uneventful. We consider that open stent-grafting via the aortic arch is an alternative method for repair of acute type B aortic dissection with an ULP in the descending aorta, in cases where direct closure of the intimal tear is difficult.
@Jpn. J. Cardiovasc. Surg. 34: 272-275 (2005)