CASE REPORTS   

Chirurgia 2016 October;29(5):169-73

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

Fatal retrograde Stanford type A aortic dissection associated with aortic clamp in descending aortic surgery

Hiroyuki SAISHO, Satoru TOBINAGA, Koji AKASU, Hidetoshi AKASHI, Hiroyuki TANAKA

Department of Surgery, Kurume University School of Medicine, Kurume, Japan

Intraoperative retrograde Stanford type A aortic dissection during descending aortic surgery is a rare but potentially fatal complication. It is of particular concern in patients with chronic aortic dissection who need aortic cross clamping at the aortic arch, as the aortic walls in such patients could be fragile. Between 2002 and 2012, three patients suffered intraoperative retrograde Stanford type A aortic dissection during descending aortic replacement at our hospital. In each case we carried out descending aortic replacement through a left anterolateral thoracotomy with partial femoro-femoral cardiopulmonary bypass. Aortic cross clamping was performed between the left carotid artery and the left subclavian artery. The graft replacement was completed uneventfully, but after declamping the aorta, a dissection was found in two of the three patients by visual inspection and intraoperative echography. The dissection was discovered in the third patient at autopsy 2 days after the operation. Additional graft replacement of the ascending and total aortic arch was performed in two patients. An intimal tear was found at the aortic cross clamping site in all three cases. Dissection can originate at the site of any intimal injury resulting from surgical procedures on the aorta. Here, we report three cases of intraoperative retrograde Stanford type A aortic dissection that occurred during descending aortic replacement.