Vascular complications associated with spontaneous aortic dissection

Abstract

Three hundred twenty-five cases of spontaneous aortic dissection seen at two institutions between 1965 and 1986 were reviewed to assess the incidence, morbid sequelae, and specific management of aortic branch compromise. Noncardiac vascular complications occurred in 33% of the study group, and in these patients the overall mortality rate (51%) was significantly (p less than 0.001) higher than in patients without (29%) such complications. Although aortic rupture was the strongest correlate of mortality (90%), death specifically related to vascular occlusion was common when such occlusion occurred in the carotid, mesenteric, and renal circulation. There was a strong correlation between stroke and carotid occlusion (22/26 cases), yet specific carotid revascularization was only used during the chronic phase of the disease. Similarly, peripheral operation was ineffective in reducing the mortality rate in the setting of mesenteric (87%) and renal (50%) ischemia. Fifteen patients required either fenestration or graft replacement of the abdominal aorta for acute obstruction, rupture, or chronic aneurysm development. Thirty-eight patients (12%) demonstrated some degree of lower extremity ischemia, and one third of these required a direct approach on the abdominal aorta or iliofemoral segments to restore circulation. Selected patients with acute aortic dissection may require peripheral vascular operation in accordance with a treatment strategy that directs initial attention to the immediate life-threatening complications.

Acute Complex Type A Dissection associated with peripheral malperfusion syndrome treated with a staged approach guided by lactate levels

“…Our approach recommends that a consistent fall in lactate during this interim period may represent the ischemia as resolving. One can therefore perform a delayed repair of the proximal aortic dissection [11] providing a decreased intra-operative risk to the patient. Individuals with persistently high lactate levels may then require a revascularization procedure at that time rather than delaying intervention in anticipation of clinical signs.…”

An uncommon cause of acute abdomen: Aortic dissection complicated by superior mesenteric artery occlusion

“…1 In aortic dissection, only 3-5% of cases are found to be complicated by an SMA occlusion. 2,3 There are idiopathic and secondary types of pneumatosis intestinalis 4 . Intestinal necrosis is the most common cause in the secondary type, which also includes conditions like mucosal disruption (peptic ulcer, bowel obstruction, endoscopy-related complications); increased mucosal permeability (steroid therapy, chemotherapy, collagen vascular disease, organ transplantation); and pulmonary disease (asthma, COPD).…”

“…1 In aortic dissection, only 3-5% of cases are found to be complicated by an SMA occlusion. 2,3 There are idiopathic and secondary types of pneumatosis intestinalis 4 . Intestinal necrosis is the most common…”

“…The plain X-ray abdomen revealed the ileus of the small intestine. His abnormal laboratory tests included a mild leukocytosis, white blood cell count of 12 000 mm 3 (normal range: 6000-10 000 mm 3…”

Acute Type A Aortic Dissection Involving Right Coronary Artery Orifice in a Case Presenting with Anterior ST Elevation: A Rare Case Report

“…Both conditions are uncommon in the literature, but the incidence of the latter is rarer than of the former. There were at least 4 mechanisms of aortic branch obstruction reported by Cambria et al [13] based on autopsy findings. The basic mechanisms involve bulging of the dissected false lumen at the branch orifice, subsequent distal thrombosis, eventual intimal detachment at the branch orifice, and dissection extending into the branch orifice.…”