Purpose. The objective of this report is to present a novel technical hybrid (open/endovascular) approach to mesenteric malperfusion in patients with either acute type A or acute type B aortic dissection.
Case Report #1. The patient presented with a type B aortic dissection with mesenteric malperfusion. This was treated by endovascular stenting and re-capture of the true lumen of the thoracic aorta without successful reperfusion of the SMA. Immediate laparotomy with retrograde stenting of the superior mesenteric artery (SMA) proved life-saving for the patient.
Case Report #2. The patient presented with a type A aortic dissection and mesenteric malperfusion of the intestines and right leg. Due to the patient’s clinical presentation and a high suspicion of severe intestinal ischemia, exploratory laparotomy instead of ascending arch repair was undertaken. We were able to improve mesenteric perfusion by accessing the SMA in a retrograde fashion. The dissecting intimal flap was fenestrated and stented. The patient eventually succumbed to the disease despite a patent SMA. Conclusion. A hybrid open and endovascular approach can be performed when one is required to visualize the intestines to evaluate its viability in a type A or type B aortic dissection.
Mukherjee D, Hashemi H, Lee LC. Hybrid open and endovascular treatment of type A & type B aortic dissection with mesenteric malperfusion. Vascular Disease Management, 2011, 8(5), 105-8.