Surgical treatment of a chronic thoracoabdominal dissection with false lumen thrombosis and true lumen compression determining multivisceral ischemia

Introduction The treatment of a chronic type B aortic dissection can be challenging and need a precise and multidisciplinary planning. Materials and Results A 62-year-old man presented to our hospital with acute aortic thrombosis on chronic thoracoabdominal dissection with bowel and kidney ischemia. He was submitted to urgent open surgical treatment with replacement of thoracoabdominal aorta and reimplantation of celiac trunk, superior mesenteric artery and right renal artery. During the intervention the visceral perfusion was provided with a modified Gott shunt; while the lower limb perfusion was provided by an existing right axillo-femoral and femoro-femoral bypass. The patient had a favorable course and did not report any complications. Conclusion The ideal management strategy of complex post-dissection conditions has to be tailored on the single patient's features to provide the maximal efficacy and safety. If the endovascular treatment is not viable, open surgery represents a valid option.