Hybrid Arch Type II Repair for Acute Type A-on-Chronic Type B Aortic Dissection with Paraplegia and Acute Aortic Occlusion at the Aortic Bifurcation

P0147 

Abstract Submission 

Phasakorn Noiniyom (1), Sunthorn Muangsuk (2), surin woragidpoonpol (3)

(1) Yala Hospital, Yala, Thailand, (2) Endovastec, Bangkok, Bangkok, (3) N/A, Chiang Mai

Phasakorn Noiniyom    -  Contact Me
Yala Hospital

Sunthorn Muangsug    -  Contact Me
Endovastec

surin woragidpoonpol    -  Contact Me
N/A

Phasakorn Noiniyom    -  Contact Me
Yala Hospital

CASE REPORT

Hybrid Arch Type II Repair for Acute Type A-on-Chronic Type B Aortic Dissection with Paraplegia and Acute Aortic Occlusion at the Aortic Bifurcation

Phasakorn Noiniyom, Sunthorn Muangsug

ABSTRACT

Background
Acute Type A dissection (ATAAD) remains a serious condition with high morbidity and mortality rates. Aortic dissection involving the ascending aorta may lead to various complications, ranging from malperfusion to aortic rupture, requiring immediate surgical repair. Surgical intervention in each patient will differ depending on the size of the aorta, location of the intimal tear, re-entry size, and the specific complications that necessitate tailored treatment.

Case presentation
A 46-year-old male presented with chest pain, numbness and weakness in both legs. Femoral pulse could not be palpated, and motor power was graded as 2 in both legs. One year prior to this admission, he had experienced chest pain and was diagnosed with aortic dissection type B. He had been treated solely with medication to control hypertension. After being discharged from the hospital, he lost follow-up and stopped taking all medications. Computed tomography angiography of the entire aorta revealed Stanford Type A aortic dissection with a complex triple lumen acute-on-chronic aortic dissection in the descending aorta and severe narrowing of the true lumen. Total occlusion of the aorta at the aortic bifurcation and reconstitution at both common iliac arteries were observed.Emergency surgery was performed, including Hemiarch replacement at zone 2 and total arch debranching with a branch-first technique. After weaning off cardiopulmonary bypass, both femoral pulses still could not be palpated, and arterial-line monitoring in the leg did not demonstrate an arterial waveform. TEVAR was performed, restoring arterial pressure and the arterial waveform. Following the operation, motor power improved to grade 4 and gradually continued to improve. The patient stayed in the hospital for one week and was able to walk before being discharged.

Conclusion
Hemiarch or total arch replacement plus total arch debranching with a branch-first technique are good choices for patients with aortic dissection type A, especially for young patients who still have a high risk of aortic progression. Staged TEVAR can be considered in these patients to promote better aortic remodeling. Hybrid arch type 2 procedures can also be considered if hemiarch or total arch replacement alone

Dissection