Acute Type A Aortic Dissection in a Patient with Undiagnosed Giant Cell Arteritis

P0027 

Abstract Submission 

Yuki Ikeno (1), Lucas Ribe (1), Anthony Estrera (1), Akiko Tanaka (1)

(1) McGovern Medical School at UTHealth, Houston, TX

Yuki Ikeno    -  Contact Me
McGovern Medical School at UTHealth

Lucas Ribe    -  Contact Me
McGovern Medical School at UTHealth

*Anthony Estrera    -  Contact Me
McGovern Medical School at UTHealth

Akiko Tanaka    -  Contact Me
McGovern Medical School at UTHealth

Yuki Ikeno    -  Contact Me
McGovern Medical School at UTHealth

Objective:
Acute type A aortic dissection is an extremely rare complication in a patient with previously undiagnosed giant cell arteritis (GCA). There has been only scarce data exist regarding giant cell arteritis related acute type A aortic dissection. Wie present a successful repair of acute type A aortic dissection complicated cerebral malperfusion in a patient with undiagnosed giant cell arteritis.

Methods:
A 73-year-old male with unknown past medical history presented to outside hospital with back pain and altered mental status. Subsequent computed tomography angiogram demonstrated type A aortic dissection with an occluded innominate artery. The diameter of the ascending aorta was 40 mm.

Results:
The patient was transferred to our institution, directly to the operating room from. Doppler ultrasound of the right carotid arteries revealed s decimal flow, necessitating immediate surgical intervention. Cardiopulmonary bypass was established via cannulation of the ascending aorta and bicaval drainage. Under moderate hypothermia with retrograde cerebral perfusion, the circulation was arrested. Graft replacement of the ascending and proximal transverse Zone 1 arch with a bypass to the innominate artery was performed using a Dacron graft. Circulatory arrest time was 28 minutes and lowest temperature was 21.6 ℃. Postoperatively, the patient experienced prolonged altered mental status and required reintubation due to pneumonia. Histopathological analysis revealed diffuse transmural lymphoplasmacytic infiltration with giant cells, consistent with GCA, alongside marked medial elastin fiber degradation, intimal fibrosis, and severe atherosclerosis. Subsequent CT imaging uncovered multiple cerebral aneurysms, prompting the initiation of steroid therapy.

Conclusions:
The surgical outcome of giant cell arteritis related acute type A aortic dissection was acceptable, even though the patient was complicated with cerebral malperfusion. It also highlights the necessity of vigilant assessment for large vessel complications, including cerebral aneurysms, in GCA patients, and the importance of early steroid therapy in this unique patient population.

Aortic Surgery Forum (Basic Aortic Research, Venue for Residents, Fellows, Junior Attendings)