Type B Dissection Complicated with Subacute Visceral Ischemia

Abstract

A 63-year old man presented with back pain and abdominal pain that worsened after eating. Contrast-enhanced computed tomography revealed type B aortic dissection. Arteriography 20 days after dissection revealed celiac trunk stenosis and the superior mesenteric artery did not arise from the true lumen. Saphenous vein bypass grafting from the right common iliac artery to the superior mesenteric and gastroduodenal arteries was performed. The postoperative course was uneventful and the abdominal symptoms completely disappeared.

Complicated acute type B aortic dissection: Midterm results of emergency endovascular stent–grafting

“…13,17,18 Open surgical mortality risk is high compared to emergency endovascular stent-grafting, as we first reported in 1999. 6 Even with endovascular treatment, 19,20 mortality risk can still be high (25% in this small series), with some deaths due to irreversible infarction of distal end organs. Our stent-graft strategy is based on the notion that early reversal of the most severe acute malperfusion complications will allow the patient to be resuscitated and clinically stabilized,, [21][22][23] after which more definitive treatment, possibly including open surgical repair, can be accomplished with lower cumulative risk.…”