Document Detail


Acute aortic occlusion due to false-lumen expansion after repair of abdominal aortic rupture in type B acute aortic dissection.
MedLine Citation:
PMID:  20471797     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We describe a patient with aortic occlusion due to false-lumen expansion after repair of abdominal aortic rupture in acute type B aortic dissection. A 70-year-old man presented to a nearby hospital with severe lower back pain, and was subsequently referred to our hospital with a diagnosis of abdominal aortic rupture. Computed tomography scanning on admission revealed type B aortic dissection with concomitant false-lumen rupture at the level of pre-existing infrarenal abdominal aortic aneurysm. The patient underwent abdominal aortic replacement with the true lumen reconstructed using a bifurcated knitted Dacron graft. On postoperative day 2, the patient developed severe lower body ischemia. Computed tomography scanning revealed complete true-lumen occlusion at the renal artery level because of false-lumen expansion. The patient underwent open fenestration by opening the bulging flap with a transverse graftotomy distal to the proximal graft anastomosis. After fenestration, the patient developed severe metabolic complications (i.e., myonephropathic-metabolic syndrome) and died a day later of cardiac arrest resulting from hyperkalemia. Abdominal aortic replacement with true-lumen reconstruction in patients with abdominal aortic rupture in type B acute aortic dissection could also lead to acute aortic occlusion due to re-dissection or true-lumen compromise accompanying retrograde propagation of false-lumen thrombosis. This lethal sequela after true-lumen reconstruction might be prevented by an adjuvant procedure such as concomitant fenestration.
Authors:
Hiroshi Yamamoto; Fumio Yamamoto; Hiroshi Izumoto; Keisuke Shiroto; Fuminobu Tanaka; Gembu Yamaura; Mamika Motokawa; Kazuyuki Ishibashi
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2010-05-14
Journal Detail:
Title:  Annals of vascular surgery     Volume:  24     ISSN:  1615-5947     ISO Abbreviation:  Ann Vasc Surg     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-13     Completed Date:  2011-01-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8703941     Medline TA:  Ann Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  951.e1-6     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Cardiovascular Surgery, Akita University School of Medicine, Akita, Japan.
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MeSH Terms
Descriptor/Qualifier:
Accidents, Traffic
Acute Disease
Aged
Aneurysm, Dissecting / complications,  radiography,  surgery*
Aortic Aneurysm, Abdominal / complications,  radiography,  surgery*
Aortic Diseases / etiology*,  radiography,  surgery
Aortic Rupture / etiology,  radiography,  surgery*
Aortography / methods
Arterial Occlusive Diseases / etiology*,  radiography,  surgery
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation / adverse effects*,  instrumentation
Fatal Outcome
Hematoma / etiology,  surgery
Humans
Male
Polyethylene Terephthalates
Prosthesis Design
Reoperation
Tomography, X-Ray Computed
Treatment Outcome
Chemical
Reg. No./Substance:
0/Polyethylene Terephthalates

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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