Successful Emergency Stenting of a Visceral Branch Prior to Central Aortic Repair in Type A Aortic Dissection with Mesenteric Malperfusion: A Case Report

TL;DR

A patient with a severe aortic dissection and intestinal ischemia was successfully treated with a staged approach, first restoring blood flow to the intestines before repairing the aorta.

Contribution

This case demonstrates the effectiveness of prioritizing visceral revascularization before central aortic repair in complex aortic dissections.

Findings

Emergency endovascular stenting of the superior mesenteric artery restored intestinal perfusion.

The staged approach enabled successful aortic repair without complications.

The patient recovered and was discharged ambulatory after 20 days.

Abstract

Stanford Type A acute aortic dissection (AAD) complicated by mesenteric malperfusion has a mortality rate exceeding 60%. Conventional immediate central aortic repair may be inadequate in such complex cases. Emerging evidence suggests that a staged approach may improve outcomes.

A 71-year-old male presented with acute chest pain and was diagnosed with Stanford Type A AAD extending to the abdominal aorta, with superior mesenteric artery (SMA) dissection leading to intestinal ischemia. To restore intestinal perfusion, emergency endovascular SMA stenting was performed as the initial intervention, followed by ascending aorta and total arch replacement using the frozen elephant trunk technique 12 hours later. The patient recovered without complications and was discharged ambulatory on postoperative day 20.

This case highlights the efficacy of a staged approach prioritizing mesenteric revascularization before central aortic repair in AAD complicated by visceral malperfusion. By first addressing end-organ ischemia, we potentially mitigated the risk of irreversible bowel necrosis while enabling subsequent central aortic repair. Our experience adds to the growing body of evidence supporting individualized, pathophysiology-guided treatment strategies for this challenging clinical scenario.

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