A Successful Surgical Repair for Mesenteric Ischemia Associated with Acute Type A Dissection

(Department of Cardiovascular Surgery, Kinan Hospital, Wakayama, Japan)

Keiji Iwata Yasuhisa Shimazaki , Tomohiko Sakamoto
A 65-year-old woman presented to a local hospital with chest, back and right leg pain. She was transferred to our hospital because her abdominal pain gradually increased. CT scan demonstrated an acute type A aortic dissection from the proximal ascending aorta to the right common iliac artery, with a 48mm diameter in the ascending aorta. The proximal superior mesenteric artery(SMA)was completely occluded by the thrombosed false lumen. Echocardiography showed minor aortic regurgitation, and no pericardial effusion. Her hemodynamics were stable, but abdominal pain persisted. Emergency laparotomy, performed because of mesenteric infarction with intestinal necrosis, provided no evidence of any intestinal necrosis. She underwent left external iliac artery to distal SMA bypass with a saphenous vein graft, because the intestine looked pale. Then the total arch replacement was performed two days later. The patient’s postoperative course was uneventful, and her abdominal symptom completely disappeared.
  Jpn. J. Cardiovasc. Surg. 38:56-59(2009)