# Successful treatment of giant abdominal aortic aneurysm with chronic contained rupture diagnosed at the onset of acute retrograde type A aortic dissection: A case report

## TL;DR

A rare case of a giant abdominal aortic aneurysm and aortic dissection was successfully treated with staged surgical and conservative approaches.

## Contribution

Demonstrates a successful two-phase treatment strategy for a rare combination of aortic conditions.

## Key findings

- Conservative management of acute aortic dissection followed by elective surgery for the aneurysm was effective.
- Tailor-made grafts enabled successful vascular reconstruction during open surgery.
- Staged treatment allowed safe laparotomy during the chronic phase of aortic dissection.

## Abstract

It is rare for two critical diseases, namely a giant abdominal aortic aneurysm (AAA) and acute type A aortic dissection (TAAD), to be detected simultaneously, and in such instances, management is extremely difficult.

A 64-year-old man who presented to our hospital with a chief complaint of sudden back pain and vomiting was diagnosed with acute retrograde TAAD and a giant AAA with chronic contained rupture (CCR) via computed tomography. We initially managed the acute TAAD conservatively and subsequently performed laparotomy for the AAA 3 months later. During open surgery, we performed vascular reconstruction using a tailor-made tapering graft.

Emergency surgery is recommended for AAA with CCR or retrograde TAAD with a patent false lumen, and the prognosis of conservative treatments for these cases is currently unknown. However, concurrent surgery for this condition is extremely invasive. Fortunately, the patient in this case survived the acute phase, and laparotomy for the AAA could be safely performed during the chronic phase of the TAAD.

We successfully treated a giant AAA with CCR by selecting the appropriate surgical timing and method. In cases of combined CCR of a giant AAA and retrograde TAAD, conservative management may be attempted to convert the acute dissection to a chronic one, thereby allowing elective repair of the AAA.

•TAAD and giant AAA present unique management challenges.•Conservative TAAD management, followed by AAA laparotomy, proved successful.•Safe laparotomy performed during TAAD chronic phase, ensuring patient survival•Vascular reconstruction utilized tailor-made graft during open surgery.

TAAD and giant AAA present unique management challenges.

Conservative TAAD management, followed by AAA laparotomy, proved successful.

Safe laparotomy performed during TAAD chronic phase, ensuring patient survival

Vascular reconstruction utilized tailor-made graft during open surgery.