Stanford Type A Acute Aortic Dissection Complicated with Intestinal Ischemia Preceded by Superior Mesenteric Artery Bypass:Report of a Case

A 78-year-old male with sudden onset of chest and back pain was transported to our institution by ambulance. Upon arrival at our hospital, he also complained of abdominal pain. Contrast-enhanced computed tomography (CT) revealed the presence of Stanford type A acute aortic dissection complicated wit...

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Published inKyobu geka. The Japanese journal of thoracic surgery Vol. 76; no. 5; p. 375
Main Authors Sakaki, Kenjiro, Onishi, Yoshihiko, Toyoda, Makoto, Yamamoto, Nobuyuki, Shibata, Ko, Nie, Masaki, Ohara, Kuniyoshi
Format Journal Article
LanguageJapanese
Published Japan 01.05.2023
Subjects
Aged
Aorta, Abdominal
Aortic Dissection - complications
Aortic Dissection - diagnostic imaging
Aortic Dissection - surgery
Humans
Ischemia - etiology
Ischemia - surgery
Male
Mesenteric Artery, Superior
Mesenteric Ischemia - diagnostic imaging
Mesenteric Ischemia - etiology
Mesenteric Ischemia - surgery
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Summary:A 78-year-old male with sudden onset of chest and back pain was transported to our institution by ambulance. Upon arrival at our hospital, he also complained of abdominal pain. Contrast-enhanced computed tomography (CT) revealed the presence of Stanford type A acute aortic dissection complicated with intestinal ischemia;because of the effects of aortic dissection, the superior mesenteric artery 378 Vol.76 No.5(2023-5) (SMA) was obstructed, leading to the complication of intestinal ischemia. An arterial blood gas test showed elevated lactate and metabolic acidosis. We immediately performed resection of the necrotic portion of the intestine and bypass of the common iliac artery to the SMA. Subsequently, after confirmation of the improvement of acidosis, ascending aortic replacement was performed on the same day. Although the patient's condition was complicated by acute kidney injury and pneumonia, he was discharged home on the 55th postoperative day. Acute aortic dissection complicated by intestinal ischemia has a poor prognosis;however, here we reported a life-saving surgical procedure in a patient with this presentation.
ISSN:0021-5252