Treatment of acute aortic dissection type A with paraplegia and distal limb ischemia within a hybrid operating room

Abstract

Abstract Objective Acute aortic dissection type A is among the most lethal surgical emergencies. Patients may suffer from occlusion of the aorta or its branches causing end-organ malperfusion complicating the diagnosis and worsening the prognosis. Paraplegia is a rare manifestation that affects less than 5% of patients. If type A aortic dissection and occlusion of the downstream thoraco-abdominal aorta occur simultaneously and require acute treatment, a medical dilemma occurs; what should be treated first? Case report We describe a case with an extensive acute type A aortic dissection with signs of consciousness and severe malperfusion syndrome. Results The treatment was successfully performed within a hybrid surgery suite with simultaneous open surgery and endovascular repair techniques supported by cardiopulmonary bypass circulation. Conclusion A hybrid operating room might offer the opportunity to simultaneously repair complicated aortic dissection with malperfusion syndrome, by open aortic surgery and endovascular techniques.

Keywords

• Type A aortic dissection
• Malperfusion syndrome
• TEVAR
• Hybrid surgery