PMC3265073_01
((a) and (b)) Preoperative computed tomography images demonstrating intramural hematoma in the ascending part of aorta. (c) Reveal classic dissection of the aortic arch with false and true lumen. (d) Reconstructed view.
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A thoracic and abdominal CT angiography demonstrated classic dissection of the aortic arch with false and true lumen starting distally to the brachiocephalic trunk and extending downward to the middle part of the thoracic descending aorta (Figures 1(b) and 1(c)). True lumen of the distal aortic arch gave rise to the left common carotid artery and left subclavian artery (Figure 1(d)). Circular, crescent thickening of the ascending aortic wall on CT angiographic images well corresponded with the subtle circular rim of increased density (up to 60 HU) in nonenhanced images suggesting life-threatening acute aortic syndrome:intramural hematoma (Figures 1(a) and 1(b)).
Illustration of the surgical technique. The carotid-to-carotid bypass with subsequent revascularization of left subclavian artery with the proximal segments ligation of the left carotid and left subclavian arteries. Endovascular stenting on the aortic arch and aortic debranching.
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Our goal was to exclude the damaged segment of the aorta and to obliterate the entry of blood into the false lumen (both at the initial intimal tear and at the secondary tears along the vessel) (Figure 2).
Computed tomographic angiogram at postoperative four weeks later. ((a) and (b)) No observation of intramural hematoma. (c) No observation of true and false lumen. (d) Reconstructed view of the aorta and endograft.
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Follow-up CT scan demonstrated the correct graft positioning, closure of the entry tear and homogenous enhancement of the branches of the aortic arch (Figures 3(b), 3(c), and 3(d)).