Delayed surgical strategy for type A aortic dissection associated with acute hepatitis C cryoglobulinaemia

An aortic dissection is a condition resulting from a tunica intima tear of the aortic wall creating a 'false lumen'. An acute Stanford type A (involves the aortic arch and/or ascending aorta) aortic dissection requires emergency surgical repair. To our knowledge, we report the first case in the literature where the treatment for an acute type A aortic dissection was intentionally delayed. This was decided following a multidisciplinary team discussion where it was agreed that the patient's active hepatitis C infection should be treated prior to surgery. The patient re-presented to the hospital 4 months later with acute dyspnoea and orthopnoea where he was diagnosed with an acute-on-chronic type A aortic dissection with trachea compression. This was successfully treated with emergency surgery. However, the patient suffered residual dyspnoea, likely due to phrenic nerve injury demonstrating the impact of untreated aortic arch distension on the neighbouring trachea and phrenic nerve.