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. 2022 Aug 2;8(1):149.
doi: 10.1186/s40792-022-01505-7.

Treatment of acute aortic dissection type A with paraplegia and distal limb ischemia within a hybrid operating room

Venny Lise Kvalheim  1   2 , Maria Devold Soknes  3 , Guttorm Lysvold Jenssen  4 , Rune Haaverstad  3   5
Affiliations

Treatment of acute aortic dissection type A with paraplegia and distal limb ischemia within a hybrid operating room

Venny Lise Kvalheim et al. Surg Case Rep. .

Abstract

Objective: Acute aortic dissection type A is among the most lethal surgical emergencies. Patients may suffer from occlusion of the aorta or its branches causing end-organ malperfusion complicating the diagnosis and worsening the prognosis. Paraplegia is a rare manifestation that affects less than 5% of patients. If type A aortic dissection and occlusion of the downstream thoraco-abdominal aorta occur simultaneously and require acute treatment, a medical dilemma occurs; what should be treated first?

Case report: We describe a case with an extensive acute type A aortic dissection with signs of consciousness and severe malperfusion syndrome.

Results: The treatment was successfully performed within a hybrid surgery suite with simultaneous open surgery and endovascular repair techniques supported by cardiopulmonary bypass circulation.

Conclusion: A hybrid operating room might offer the opportunity to simultaneously repair complicated aortic dissection with malperfusion syndrome, by open aortic surgery and endovascular techniques.

Keywords: Hybrid surgery; Malperfusion syndrome; TEVAR; Type A aortic dissection.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Aortic dissection type A (A) with subtotal occlusion of the descending and abdominal aorta (B) causing extensive distal organ malperfusion with subtotal occlusion of pelvic vessels
Fig. 2
Fig. 2
A Antegrade angiography showing improved perfusion in the descending aorta, but remaining occlusion in the abdominal aorta. B Stent graft implantation in the descending aorta with the subsequent improvement of the abdominal aortic circulation
Fig. 3
Fig. 3
Stenosis (A) of the right renal artery treated with a stent assuring good perfusion to the right kidney (B)
Fig. 4
Fig. 4
Occlusion of the right iliac artery before (A) and after stenting (B)
Fig. 5
Fig. 5
Schematic drawing of the complete hybrid procedure of open surgery with supracoronary tubegraft in the ascending aorta, thoracic aortic stent-grafting and stents in the right renal artery and right external iliac artery
See this image and copyright information in PMC

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References

    1. Perera NK, et al. Optimal management of acute type A aortic dissection with mesenteric malperfusion. Interact Cardiovasc Thorac Surg. 2014;19(2):290–294. doi: 10.1093/icvts/ivu127. - DOI - PubMed
    1. Geirsson A, et al. Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations. Eur J Cardiothorac Surg. 2007;32(2):255–262. doi: 10.1016/j.ejcts.2007.04.012. - DOI - PubMed
    1. Di Eusanio M, et al. Clinical presentation, management, and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion: observations from the International Registry of Acute Aortic Dissection. J Thorac Cardiovasc Surg. 2013;145(2):385–390. doi: 10.1016/j.jtcvs.2012.01.042. - DOI - PubMed
    1. Kamman AV, et al. Visceral malperfusion in aortic dissection: The Michigan experience. Semin Thorac Cardiovasc Surg. 2017;29(2):173–178. doi: 10.1053/j.semtcvs.2016.10.002. - DOI - PubMed
    1. Tanaka K, et al. Hybrid treatment for type A acute aortic dissection with multiorgan malperfusion. Ann Thorac Surg. 2014;98(3):1118–1120. doi: 10.1016/j.athoracsur.2014.01.079. - DOI - PubMed

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