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Alan P. Kypson
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J Thorac Cardiovasc Surg 2009;138:1031-1032
© 2009 The American Association for Thoracic Surgery

Brief Technique Report

Delayed type A dissection after arch transposition and stent graft therapy of a type B dissection

Curtis A. Anderson, MD*, Evelio Rodriguez, MD, Michael C. Stoner, MD, Alan P. Kypson, MD

Department of Cardiovascular Sciences, East Carolina University, Greenville, NC

Received for publication February 10, 2008; revisions received July 10, 2008; accepted for publication August 7, 2008.

* Address for reprints: Curtis A. Anderson, MD, Department of Cardiovascular Sciences, East Carolina University, 600 Moye Blvd, Room 252, Greenville, NC 27834. (Email: andersoncu@ecu.edu).

The first 20% of the full text of this article appears below.


   Introduction
 
Open surgical repair of descending aortic dissection is associated with high mortality in the acute setting. Intervention is required, however, for patients presenting with malperfusion, threatened rupture, or aneurysmal degeneration. Endoluminal stent grafting for complicated type B dissection has emerged as an alternative to open surgical intervention, demonstrating superior short-term outcomes.1Go Herein, we present a delayed type A dissection complicating total arch transposition and stent graft therapy of a descending aortic dissection. Treatment and preventative measures are discussed.


   Clinical Summary
 
A 50-year-old man with hypertension presented with an acute type B aortic dissection. His arch and descending aorta were dilated to 4.5 cm on computed tomographic (CT) scanning. He remained stable without evidence of malperfusion and was managed medically. Repeat CT scans performed 2 months after discharge showed expansion of the descending aorta to 5.5 cm. The standard surgical approach through a left thoracotomy would have required circulatory arrest because of the size of his aortic arch.

Endovascular treatment of the . . . [Full Text of this Article]






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