Distal Aortic Arch Aneurysm, Acute type B Aortic Dissection, and Acute Bilateral Limb Ischemia Treated by Two-stage Total Arch Replacement;Report of a Case
Hashimoto, K.; Itoh, S.; Tajima, Y.; Kimura, N.; Yuri, K.; Matumoto, H.; Adachi, K.; Yamaguchi, A.; Adachi, H.
Kyobu Geka. Japanese Journal of Thoracic Surgery 68(5): 371-374
2015
ISSN/ISBN: 0021-5252 PMID: 25963786 Document Number: 685170
A 74-year-old female patient experienced sudden and severe pain in her lower back and both legs. Upon examination, her femoral pulses were weak, and her legs were pale. Computed tomography revealed a 66-mm thoracic aneurysm in the distal arch and type B aortic dissection. Stenosis was present from the terminal aorta to the iliac arteries. The left common iliac artery was occluded at its bifurcation, and both lower limbs were ischemic. We performed bilateral axillary-femoral artery bypass, which improved blood flow to both limbs. The next day, it was apparent that compartment syndrome had developed in the patient's left leg. Rehabilitation therapy was effective for the compartment syndrome, the patient's symptoms resolved, and she was discharged. We later performed two-stage total arch replacement, and the subsequent clinical course has been without incident.