Revascularization and central repair procedure
Catheter IVR for mesenteric malperfusion was performed by radiologists.
Percutaneous access to the mesenteric artery was obtained from a common
femoral artery approach using a 6- or 7-Fr sheath. Lesions were crossed
with a 0.035-inch, angle or straight, hydrophilic guidewire with or
without a supporting 4-Fr straight catheter. Mesenteric lesions were
treated with primary stenting using a self-expanding stent.
Transesophageal echocardiography has been performed during IVR and
central repair (Figure 1a); this modality enables evaluation of cardiac
function, aortic valve regurgitation, and cardiac effusion, and
moreover, it enables detection of whether the guidewire is placed in the
true lumen or not during IVR.
Central aortic repair was performed through a median sternotomy using
cardiopulmonary bypass with selective cerebral perfusion.
Cardiopulmonary bypass was established with femoral artery and right
axillar artery cannulation and bicaval venous drainage. After left
ventricular venting, the patient was cooled down to 25°C. Then aortic
arch repair for entry closure and true lumen reinstallation was
performed. The replacement range was determined depending on the
position of the entry. When aortic dissection extended to the aortic
root and detachment of the aortic valve commissure occurred, the
valvular resuspension technique was adopted.