Ann Thorac Surg 1999;68:1068-1069
© 1999 The Society of Thoracic Surgeons
Invited Commentary
Gerald M. Lawrie, MDa
a Texas Surgical Associates, 6560 Fannin 1842, Houston, TX 77030, USA
Invited commentary
Acute dissecting aneurysms are notoriously treacherous and unpredictable in their behavior. There was an excellent result in this patient, despite the long delay between the onset of the dissection and the surgical repair of the aorta. Redirection of flow into the true lumen by the operation performed here, is our first-line approach to distal ischemia from dissections. However, it must be emphasized that the final result distally is unpredictable, and not always as successful as in this case. Unless prompt and complete resolution of ischemia is noted after surgery, immediate follow-up arteriography is indicated. Careful clinical monitoring for any symptoms or signs in the perioperative period is essential. We have
had patients who experienced persistent mesenteric ischemia despite restoration of urine output and the femoral pulses. Similarly, if the septum between the true and false lumen is displaced abnormally in a localized area when flow is restored to the true lumen, then ischemia in one area may be alleviated while new ischemia may appear elsewhere. Careful lifelong follow-up by computed tomography scan or magnetic resonance imaging of the aorta is also an important part of the management of these patients.
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[Abstract]
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