The extensive fenestration by patency of the abdominal aorta and renal arteries as immediate treatment in Stanford B-type of acute thoraco - abdominal aortic dissection complicated by acute kidney and a lower limb ischemia

Abstract

The dissecting aneurysm occurs as a result of rupture of the aortic intima. About 30% of all dissections show the Stanford B-type access in the descending aorta. The surgical intervention is justified only by symptoms of breaking or closing by aortic dissection and/or its branches (e.g. acute intestinal, renal or lower limbs ischemia). During 2001–2007 three patients in Zamosc have been treated surgically for the Stanford B-type dissection, where the direct cause for surgical intervention originate from acute ischemia of the lower limb and kidney. Here we describe a surgical method of extensive fenestration by patency of the abdominal aorta and renal arteries, connected to a necessary reconstruction of the aorto-iliac section. We did not have any deaths in post-surgical period (average of 63 months). One patient underwent a necessary chemodialitic treatment because of acute post-surgical kidneys insufficiency (a full functional recovery was obtained). In about two months from the surgery another patient underwent a successful implantation of a stentgraft into his descending aorta in order to close the entry of dissection. It seems that the applied surgical solution allows the immediate removal of a life-threatening condition in the case of organ complications in the critical part of aorta, between diaphragm and the level of the renal arteries. In the second stage of the procedure it is also possible to apply intravascular stenting in order to close the entry of dissection in thoracic aorta.