RESUMO
Type A aortic dissection (TAAD) can be complicated by myocardial ischemia due to extension of the dissection into coronary artery or by extrinsic compression of a coronary artery by the false lumen. We present the successful surgical management of a hemodynamically unstable patient with acute aortic dissection with ongoing myocardial ischemia by stenting the left main system prior to the surgical repair of TAAD.
Assuntos
Angioplastia Coronária com Balão/métodos , Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Estenose Coronária/cirurgia , Vasos Coronários/cirurgia , Stents , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico , Aortografia , Angiografia Coronária , Estenose Coronária/complicações , Estenose Coronária/diagnóstico , Ecocardiografia , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The purpose of this study was to review the shift in the trend of management and mid-term outcomes of all patients who sustain thoracic aortic injury. A Retrospective analysis was performed of all patients sustaining blunt thoracic aortic trauma admitted to our unit. Forty-seven patients were presented with injury to the thoracic aorta following blunt chest injury. Ten patients underwent open surgical repair of their thoracic aortic injury. The mean age ± SD (range) was 29.4 ± 7.9 years (18-41) with a mean Injury Severity Score (ISS) of 41 ± 14.7 (25-75). Fifteen patients underwent thoracic endovascular repair for blunt aortic transections with a mean age of 35.1 ± 14.5 years (17-65), mean ISS of 40.8 ± 13.9 (20-75) and an average length of hospital stay of 25.6 ± 14.5 days (3-77). The mean aortic diameter proximal to the aortic injury was 23.46 ± 3.02 mm (19-28) with a mean aortic angulation of 58.46° ± 17.73 (44-80°). The mean oversizing was 24.4 ± 5.4% (17-32%). At our institution, there has been a paradigm shift in the emergent repair of blunt thoracic aortic injury from open surgery to endovascular repair. Oversizing of the stent-graft did not translate to a poorer outcome.