Transaortic Septectomy as Treatment for Chronic Mesenteric Ischemia After Aortic Dissection

Visceral ischemia can present as an acute or chronic complication of aortic dissection, which is associated with high morbidity and mortality rates, up to 50-87%. Furthermore, the optimal management strategy for this problem is unclear. The authors present a case of chronic mesenteric ischemia complicating a Stanford type A aortic dissection which was treated with transaortic septectomy. A 56-year-old man presented with chronic abdominal pain and a 30-pound weight loss after operative repair of an ascending aortic dissection with replacement of his aortic valve and ascending aorta. Two prior attempts at balloon fenestration of his aortic dissection in the area of his mesenteric vessels had failed to improve his symptoms. Angiography, computed tomography scan, and duplex evaluation of the aorta revealed a 5 cm suprarenal aorta with the false lumen occupying the majority of the diameter. The origins of the mesenteric vessels from the true lumen were compressed by the septum. The patient underwent a septectomy and aortoplasty of his suprarenal aorta via a retroperitoneal approach. A postoperative duplex scan showed widely patent origins of the celiac, superior mesenteric, and renal arteries. The patient's postprandial pain completely resolved before hospital discharge. Aortoplasty and septectomy presents a newly described treatment of complications of aortic dissection and has been utilized in the acute and chronic settings. It allows successful treatment of aneurysmal and occlusive complications in the dissected aorta. The evaluation and operative treatment of a patient with both these complications is discussed.