Classic dissection of thoracic aorta complicated by ascending aortic intramural hematoma: promt diagnosis and successful endovascular repair

Abstract

We reported a case of 68-year-old man, with a previous history of hypertension. Patient was admitted to our institution for evaluation of a severe, constant, tearing anterior chest pain radiated to the neck with suspicion of acute aortic dissection. A multidetector computed tomography scan of thorax and abdomen demonstrated a dissection starting from the middle part of aortic arch and extending downward to the descending aorta till the middle part of the thoracic aorta. The dissection was classified as Stanford A, De Bakey I. Surgical treatment of patient was started with bypass graft from the right common carotid artery to the left common carotid with subsequent revascularization of left subclavian artery. Lower parts of above-mentioned arteries were ligated. At the second stage an emergent prosthetic stent-graft was placed distally from the truncus brachiocephalicus up to the proximal part of the descending aorta. We reported a case report to present diagnostic and possible interventional treatment for patient with acute aortic type A dissection.

Figure 1

((a) and (b)) Preoperative computed tomography images demonstrating intramural hematoma in the ascending part of aorta. (c) Reveal classic dissection of the aortic arch with false and true lumen. (d) Reconstructed view.

Figure 2

Illustration of the surgical technique. The carotid-to-carotid bypass with subsequent revascularization of left subclavian artery with the proximal segments ligation of the left carotid and left subclavian arteries. Endovascular stenting on the aortic arch and aortic debranching.

Figure 3

Computed tomographic angiogram at postoperative four weeks later. ((a) and (b)) No observation of intramural hematoma. (c) No observation of true and false lumen. (d) Reconstructed view of the aorta and endograft.