Akita Sho, Tamenishi Akinori, Matsumura Yasumoto, Maruyama Kunihiro, Ito Jun
Department of Cardiac Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan.
Department of Radiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.25-0136. Epub 2025 Jun 18.
Stanford Type A acute aortic dissection (AAD) complicated by mesenteric malperfusion has a mortality rate exceeding 60%. Conventional immediate central aortic repair may be inadequate in such complex cases. Emerging evidence suggests that a staged approach may improve outcomes.
A 71-year-old male presented with acute chest pain and was diagnosed with Stanford Type A AAD extending to the abdominal aorta, with superior mesenteric artery (SMA) dissection leading to intestinal ischemia. To restore intestinal perfusion, emergency endovascular SMA stenting was performed as the initial intervention, followed by ascending aorta and total arch replacement using the frozen elephant trunk technique 12 hours later. The patient recovered without complications and was discharged ambulatory on postoperative day 20.
This case highlights the efficacy of a staged approach prioritizing mesenteric revascularization before central aortic repair in AAD complicated by visceral malperfusion. By first addressing end-organ ischemia, we potentially mitigated the risk of irreversible bowel necrosis while enabling subsequent central aortic repair. Our experience adds to the growing body of evidence supporting individualized, pathophysiology-guided treatment strategies for this challenging clinical scenario.
斯坦福A型急性主动脉夹层（AAD）合并肠系膜灌注不良时，死亡率超过60%。在这类复杂病例中，传统的立即进行主动脉中央修复可能并不充分。新出现的证据表明，分阶段治疗方法可能会改善治疗结果。
一名71岁男性因急性胸痛就诊，被诊断为累及腹主动脉的斯坦福A型AAD，伴有肠系膜上动脉（SMA）夹层导致肠道缺血。为恢复肠道灌注，最初的干预措施是进行急诊血管内SMA支架置入术，12小时后采用“冰冻象鼻”技术进行升主动脉和全弓置换。患者康复且无并发症，术后第20天可步行出院。
本病例突出了在合并内脏灌注不良的AAD中，分阶段治疗方法的有效性，该方法优先在主动脉中央修复前进行肠系膜血运重建。通过首先解决终末器官缺血问题，我们可能降低了不可逆肠坏死的风险，同时为后续的主动脉中央修复创造了条件。我们的经验为支持针对这一具有挑战性临床情况的个体化、病理生理学导向治疗策略的越来越多的证据增添了内容。
