Aorto-Cutaneous Fistula after Surgical Treatment of Stanford Type A Aortic Dissection.

ABSTRACT

An aorto-cutaneous fistula is a rare complication that occurs after aortic surgery. Due to its rarity, postoperative complications are not normally highlighted in most standard teaching. We report here a case of aorto-cutaneous fistula after surgical treatment of a Stanford type A aortic dissection (AD) in a 67-year-old Chinese male. The patient presented with severe right heart dysfunction and a mass was found in the upper-middle of his chest, which started bleeding in the next years. On admission, preoperative aortic computed tomography angiography (CTA) showed a huge hematoma located in the anterior superior mediastinum and a shunt between the embedding cavity of the aortic root and right atrium. An emergent procedure was performed. Intraoperatively, we found two leaks approximately 2 mm from the anastomosis of the greater curvature of the ascending aortic graft and stented graft after the hematoma was cleared and we confirmed the shunt had a large amount of blood flow after a right atrium incision. After the surgery, the patient was diagnosed with a cerebral hemorrhage, and his family decided to refuse therapy on the third postoperative day (p.o.d.).