J.Jpn. Surg. Soc.. 79(9): 1144-1148, 1978

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Report on the annual meeting

EMERGENCY OPERATION FOR RE-DISSECTING ANEURYSM OF THE THORACIC AORTA (DeBakey Ⅲb)

Acute dissecting aneurysm of the thoracic aorta is a serious and often fatal disease that need prompt treatment. Thirty-four patients with dissecting aneurysm of the thoracic aorta were treated in our institution. A case of emergency operation for re-dissecting aneurysm of the thoracic aorta was presented. A fourty-one years old male had aneurysmorrhaphy (resection of entry, obliteration of the false channel and end to end anastomosis) for acute dissecting aneurysm of the thoracic aorta (DeBakey IIIb) 3-1/2 years ago. He had been doing well untill 4 days prior to this admission when he suddenly developed severe back pain. Re-dissection of the descending thoracic aorta was confirmed by aortogram. With patient in the right lateral decubitus position, a fifth interspace posteror-lateral thoracotomy was made. The patient was placed on the partial femoro-femoral bypass.
After proximal and distal controls were obtained, the aneurysmal wall was incised. There was huge adventitial hematoma and entry at the root of the left subclavian artery. The true lumen was compressed by false lumen. The thoracic aneurysm was resected, the false lumens were obliterated by Teflon felt sandwitch sutures, the flow through the true lumen was reestablised by interposition of a low porosity woven dacron graft. An 8 mm dacron graft was wrap around of the distal part of the aorta near the distal anastomosis to remove tension from the suture line. The movie of the emergency surgery for re-dissection of the thoracic aorta was shown.

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