A Case of Retrograde Acute Type A Aortic Dissection Treated with Total Arch Replacement and Thoracic Endovascular Aortic Repair
- VernacularTitle:逆行性急性大動脈解離Stanford A型に対して，弓部大動脈全置換術と胸部大動脈ステントグラフト内挿術を施行した1例
- Author:
Taku NAKAGAWA
1
;
Koki YOKAWA
1
;
Makoto KUSAKISAKO
1
;
Tomonori HIGUMA
1
;
Yosuke TANAKA
1
;
Kazunori YOSHIDA
1
;
Yoshihiro OSHIMA
1
;
Hidefumi OBO
1
;
Hidetaka WAKIYAMA
1
Author Information
- Keywords: retrograde acute aortic dissection; thoracic endovascular aortic repair; total arch replacement; frozen elephant trunk
- From:Japanese Journal of Cardiovascular Surgery 2025;54(6):288-291
- CountryJapan
- Language:Japanese
- Abstract: The treatment strategy for acute type A aortic dissection consists of entry closure and maximal resection of the dissected aortic segment. In cases where the entry is located in the distal descending aorta, as in this case, entry closure is challenging, and surgery often involves only maximal resection of the dissected segment. The patient was a 53-year-old man who presented with sudden onset of chest pain. CT revealed a retrograde Stanford type A acute aortic dissection with a tear in the distal descending aorta. Preoperative measurements suggested that entry closure using frozen elephant trunk (FET) would be impossible. Surgery was performed with the goal of maximal resection of the dissected aortic segment in a hybrid operating room. The patient underwent total arch replacement (TAR) using FET. TEE revealed true lumen stenosis beyond the descending aorta, along with a decrease in lower limb blood pressure reducing blood flow to the abdominal branches. Therefore, emergency TEVAR was performed to achieve entry closure in the entire descending aorta. After TEVAR, the true lumen expanded, and perfusion to the lower limbs and abdominal branches improved. The postoperative course was uneventful, and the patient was discharged on postoperative day 10.
