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J Thorac Cardiovasc Surg 1998;116:671
© 1998 Mosby, Inc.

LETTERS TO THE EDITOR

Delayed iatrogenic aortic dissection from coronary bypass

Frank A. Baciewicz, Jr, MD

Detroit, MI

Department of Cardiothoracic Surgery, Wayne State University–Harper Hospital, 3990 John R, Ste 2120, Detroit, MI 48201

To the Editor:

I enjoyed the recent article, "Delayed Iatrogenic Aortic Dissection From Coronary Bypass Managed With Extraanatomic Bypass," by Pappas and associates (J Thorac Cardiovasc Surg 1998;115:947-9).

Fig 1, showing the computed tomographic scan of the chest, appeared to demonstrate a significant peri-aortic collection of blood, in addition to the dissection. I wondered whether the authors were concerned about a leak in the descending thoracic aorta and how they would have managed this clinical situation.

Inasmuch as the authors decided on a nonoperative approach, another option would have been catheter fenestration and stenting of the involved vessels. After repair of type I dissection, I have used catheter fenestration and postfenestration stents to alleviate leg ischemia. This option avoids an axillary bifemoral bypass or femoral-femoral bypass.





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