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Staged hybrid approach for an acute-on-chronic aortic dissection with rupture in a Jehovah's Witness patient: Case report  Sarah T. Ward, MD, Minhaj S.

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Presentation on theme: "Staged hybrid approach for an acute-on-chronic aortic dissection with rupture in a Jehovah's Witness patient: Case report  Sarah T. Ward, MD, Minhaj S."— Presentation transcript:

1 Staged hybrid approach for an acute-on-chronic aortic dissection with rupture in a Jehovah's Witness patient: Case report  Sarah T. Ward, MD, Minhaj S. Khaja, MD, MBA, David M. Williams, MD, Bo Yang, MD, PhD  The Journal of Thoracic and Cardiovascular Surgery  Volume 150, Issue 5, Pages e63-e65 (November 2015) DOI: /j.jtcvs Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 Stage 1 operation. A, An axial image from a computed tomographic angiogram 3 years before the aortic rupture demonstrates the previous appearance the of true lumen (TL) and false lumen (FL), with thrombus within much of the false lumen. B, By way of a new intimal tear, contrast material passes from the true lumen through a new false lumen channel (red arrow) in the thrombus of the chronic false lumen and merges with the chronic false lumen at the level of the diaphragm (not shown). Also notable is hyperdensity within the false lumen (blue arrow), which was present on unenhanced images (not shown) representing acute blood. Mediastinal hematoma (red arrowhead) and the true lumen are also visible. C, The coronal reconstruction of computed tomographic angiography at the same level as in panel A shows the new intimal tear (red arrow), the true lumen, the chronic false lumen, and the mediastinal hematoma (red arrowhead). D, Thoracic aortography after endograft placement confirmed patency of the endograft without flow across the new intimal tear. Also notable is calcification along the false lumen (red arrowhead). The Journal of Thoracic and Cardiovascular Surgery  , e63-e65DOI: ( /j.jtcvs ) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 Stage 2 operation. Three-dimensional reconstruction of the thoracic aorta from computed tomographic angiography before (A) and after (B) open repair. A, The endograft can be seen within the true lumen (red arrow), flow within the false lumen (blue arrow), and thrombus within the false lumen (blue arrowhead). B, The endograft was explanted and replaced with a 30-mm Hemashield vascular graft. The Journal of Thoracic and Cardiovascular Surgery  , e63-e65DOI: ( /j.jtcvs ) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

4 Acute-on-chronic dissection with rupture can be managed initially with stent grafting.
The Journal of Thoracic and Cardiovascular Surgery  , e63-e65DOI: ( /j.jtcvs ) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

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