Surgical Revascularization Of Stanford Type B Aortic Dissection Complicated By Visceral Ischemia

Objective:Aortic dissection is a kind of acute and severe cardiovascular surgery,in which the aortic intima and media tear under the action of various reasons,and the blood enters the tear cavity,resulting in double lumen changes of the aorta.Due to the different extent of dissection,there are various complications,endangering the lives of patients.Among them,visceral ischemia is one of the most challenging complications of complicated type B aortic dissection(cTBAD).Endovascular aortic repair alone can not solve the problem of abdominal organ ischemia in patients with thoracic aortic dissection.If not treated in time,patients often die because of severe abdominal organ dysfunction.At present,drug conservative treatment,interventional treatment and surgical treatment are often used to treat abdominal organ ischemia in patients with cTBAD.Each of these methods has its own advantages and disadvantages.The purpose of this study was to summarize our clinical experience of the surgical management of cTBAD with visceral ischemia using the surgical revascularization technique.Methods:We retrospectively reviewed 249 consecutive cTBAD patients receiving treatment at our institution from September 2016 to April 2020。There are 5 patients with cTBAD(2.0%)presented with visceral ischemia and received arterial revascularization.A retrospective analysis was performed among these 5 patients.Collected data included patient demographics,history,clinical presentation,laboratory findings,imaging results,managements,and outcomes.The treatment effect was evaluated by comparing the laboratory indexes before operation,after operation and before discharge.Patients were follow-up with postoperative computed tomography angiography(CTA)and echocardiography.Results:There were 4 male and 1 female patients with a median age of59.2±13.2(range 43～78)years.All patients were acute aortic dissection.Five patients treated with thoracic endovascular aortic repair(TEVAR)and concomitant visceral artery revascularization.One patient underwent surgical visceral artery revascularization alone.All the operations were successful,and there was no intraoperative death.One patient died one day after arterial revascularization due to multiple organ dysfunction syndrome.Finally,four patients recovered and discharged from the hospital after operation.Before discharge,their abdominal organ function returned to normal level,which was significantly improved compared with that before operation.The four patients were follow-up with mean follow-up time of43.5±8.2(range 32～51)months.All patients regained normal bowel function and vascular graft patency.All of them had normal function of abdominal organs,no obvious complaint of abdominal discomfort,and the grafted vessels were unobstructed.Conclusions:Early diagnosis and immediate visceral revascularization are imperative for patients with visceral malperfusion caused by cTBAD.This treatment has the advantages of wide applicability,exact curative effect and no need of secondary treatment.Our technique of abdominal organ revascularization shows good short-term and medium-term effect,and the long-term effect needs further follow-up.