Abdominal aortic tailoring for renal, visceral, and lower extremity malperfusion resulting from acute aortic dissection

Purpose: The treatment of ischemic complications that result from aortic dissection is a challenging and controversial problem. The purpose of this study was to evaluate aortic tailoring in the management of acute aortic dissection associated with visceral, renal, or lower extremity ischemia. Methods: We retrospectively reviewed the clinical courses of seven consecutive patients (five men, two women) with a median age of 68 years (range, 48 to 74 years) from January 1994 to January 1997. All patients underwent an abdominal aortic tailoring procedure for relief of ischemic complications associated with acute aortic dissection (type IIIB, n = 6; type I, n = 1) and a normal-sized aorta. Results: All seven patients survived and recovered full mesenteric, renal, and lower extremity function. Two patients required temporary hemodialysis in the immediate postoperative period. There has been no significant dilatation of the tailored aortic segments, with an average follow-up of 19 months (range, 1 to 30 months). Conclusions: Abdominal aortic tailoring represents a safe and effective method for treating ischemic complications associated with acute aortic dissection and a normal aortic luminal diameter.