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Case reports

Should we consider surgical intervention for spinal cord ischemia due to acute type B aortic dissection?

^a Department of Cardiovascular Surgery, Kobari General Hospital, Chiba, Japan
^b Department of Cardiovascular Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba 279-0021, Japan
^c Department of Cardiovascular Surgery, Juntendo University School of Medicine, Tokyo, Japan

Received 12 October 2008; received in revised form 3 December 2008; accepted 9 December 2008.

^_* Corresponding author. Tel.: +81 47 353 3111; fax: +81 47 390 8082. (Email: kkikuchi{at}juntendo-urayasu.jp).

We present a 46-year-old man with a sudden onset of severe back pain following leg pain. An emergent computed tomography showed acute type B aortic dissection. The true lumen was almost completely occluded because of compression of a massive thrombus in the false lumen. The patient developed paraplegia by the time he was taken into the operation room. After induction of anesthesia, partial cardiopulmonary bypass was initiated, and then the chest was opened via left thoracotomy. The entry was found in the distal aortic arch and was successfully repaired. The descending aorta was replaced with a Dacron graft and antegrade re-perfusion was established in the descending aorta three hours after the onset of paraplegia. The patient recovered uneventfully without any neurological deficit. Paraplegia caused by acute type B aortic dissection is a rare complication. Usually it is treated medically. However, if the true lumen is occluded due to a massive thrombus in the false lumen, multiple malperfusion of the distal organs may occur. In such a case, surgical intervention should be considered to resume antegrade perfusion in the descending aorta as soon as possible.

Key Words: Paraplegia • Acute type B aortic dissection • Thrombus • Surgical intervention