[Urgent replacement of aortic arch and descending aorta following replacement of ascending aorta for Stanford a aortic dissection--a case report].

A 37-year-old male who was on chronic dialysis regimen for IgA nephropathy developed acute Stanford A type aortic dissection. Replacement of the ascending aorta was performed with the aid of extracorporeal circulation, selective cerebral perfusion, and open distal anastomosis technique. The site of the intimal tear in the ascending aorta was resected and the gelatin-resorcin-formaldehyde (GRF) glue was applied to both stumps. The outside of dissecting aortic wall was reinforced with Teflon-felt strips. Two months after the operation, the patient required an urgent operation due to threatening spindle evolution of a persisting dissection in the descending aorta. Replacement of the total arch and the descending aorta was carried out via the median sternotomy with the left anterior thoracotomy, and a subclavian incision. Continuous veno-venous hemofiltration was initiated immediately after both operations and the water balance was maintained well. The patient was discharged 1 month postoperatively. It was suggested that the inside of the dissected aortic wall should be also reinforced even when the GRF glue was used in patients who have a fragile intimal flap and a wide tear.