A difficult-to-treat case of Stanford type A acute aortic dissection with splenic artery rupture

A 50-year-old man presenting with sudden-onset lumbago, right lower-extremity numbness, and vomiting was transferred to our hospital. On arrival, his right lower extremity was pale, and the right femoral artery was not palpable. Contrast-enhanced computed tomography demonstrated Stanford type A acute aortic dissection with a communicating false lumen causing obstruction of the right coronary artery ostium, superior mesenteric artery, and right iliac artery. Concurrently, an abdominal hematoma with contrast extravasation from the splenic artery was identified, indicating splenic artery rupture. Shortly after completion of the imaging examination, the patient’s condition rapidly deteriorated, and he was unresponsive to cardiopulmonary resuscitation. This case is rare and challenging to treat, considering the complicated type A acute aortic dissection and active bleeding from the splenic artery. The patient would have required aortic replacement surgery using extracorporeal circulation after heparinization, which could exacerbate the bleeding. This case emphasizes the need for treatment strategy discussion.