Acute aortic dissection with side branch vessel occlusion: Open surgical options

Acute aortic dissection is one of the most common catastrophes affecting the aorta. Because dissection can involve any aortic segment, the disease can manifest itself through a variety of clinical presentations. The most spectacular manifestation is frank rupture, usually into the pericardial or pleural cavity. Dissections of the ascending aorta are associated with rapidly fatal complications such as cardiac tamponade, major stroke, or massive myocardial infarction, justifying emergent operation. Dissections of the descending aorta are managed medically with surgery reserved for those patients with aortic rupture, aneurysmal dilatation, or ischemic symptoms. Aortic branch occlusion occurs in up to one third of patients with aortic dissection and is associated with increased risk of early death and serious complications. The therapeutic armamentarium of the vascular surgeon has evolved during the last 20 years to include endovascular (balloon fenestration or branch stenting) and surgical options. This article will focus on the open surgical management of patients with acute aortic dissection complicated by side branch occlusion and organ or limb malperfusion.