Download PDF
CC BY-NC-ND 4.0 · Aorta (Stamford) 2024; 12(03): 074-076
DOI: 10.1055/s-0045-1802992
Case Report

Management of Early and Late Malperfusion Syndrome in Acute Type B Aortic Dissection with Retrograde Extension Using Hybrid Zone 2 Arch Repair and Thoracic Endovascular Aortic Repair: A Case Report

Daniela Votano 
1   Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
,
Hector W.L. de Beaufort
1   Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
,
Rob H.W. van de Mortel
2   Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
,
Uday Sonker
1   Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
,
Robin H. Heijmen
3   Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
,
Hans G. Smeenk
1   Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
› Author Affiliations
Funding None.
› Further Information
Also available at
  Permissions and Reprints

Abstract

The distal extent of aortic repair in acute aortic dissection and the management of malperfusion in terms of timing and strategy are still debated topics. We present a case of acute type B dissection with retrograde extension to the ascending aorta, with the most proximal intimal tear in the descending thoracic aorta, associated with both early lower extremity and delayed mesenteric malperfusion syndrome, treated effectively by femoral artery open fenestration and hybrid zone 2 arch repair.

Keywords

aortic dissection - malperfusion - hybrid arch repair


Publication History

Received: 06 July 2023

Accepted: 10 October 2024

Article published online:
25 February 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Czerny M, Schoenhoff F, Etz C. et al. The impact of pre-operative malperfusion on outcome in acute type A aortic dissection: results from the GERAADA Registry. J Am Coll Cardiol 2015; 65 (24) 2628-2635
    CrossrefPubMedSearch in Google Scholar
  • 2 Di Eusanio M, Trimarchi S, Patel HJ. et al. Clinical presentation, management, and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion: observations from the International Registry of Acute Aortic Dissection. J Thorac Cardiovasc Surg 2013; 145 (02) 385-390.e1
    CrossrefPubMedSearch in Google Scholar
  • 3 Lombardi JV, Hughes GC, Appoo JJ. et al. Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. J Vasc Surg 2020; 71 (03) 723-747
    CrossrefPubMedSearch in Google Scholar
  • 4 Czerny M, Schmidli J, Adler S. et al; EACTS/ESVS Scientific Document Group. Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS). Eur J Cardiothorac Surg 2019; 55 (01) 133-162
    CrossrefPubMedSearch in Google Scholar
  • 5 Uchida K, Karube N, Kasama K. et al. Early reperfusion strategy improves the outcomes of surgery for type A acute aortic dissection with malperfusion. J Thorac Cardiovasc Surg 2018; 156 (02) 483-489
    CrossrefPubMedSearch in Google Scholar
  • 6 Desai ND, Hoedt A, Wang G. et al. Simplifying aortic arch surgery: open zone 2 arch with single branched thoracic endovascular aortic repair completion. Ann Cardiothorac Surg 2018; 7 (03) 351-356
    CrossrefPubMedSearch in Google Scholar
  • 7 Smith T, Heijmen RH. Staged, hybrid approach to acute DeBakey Type I aortic dissection. J Vis Surg 2021; 7: 22-22
    CrossrefPubMedSearch in Google Scholar
  • 8 Etz CD, Kari FA, Mueller CS. et al. The collateral network concept: a reassessment of the anatomy of spinal cord perfusion. J Thorac Cardiovasc Surg 2011; 141 (04) 1020-1028
    CrossrefPubMedSearch in Google Scholar