Hemolysis following wrap aortoplasty for Type A aortic dissection repair: Case report and review of the literature

A Dacron wrap aortoplasty has been described as an adjunct to reduction ascending aortoplasty for the repair of Type A aortic dissections. We report a case of an uncomplicated hemiarch repair with wrap aortoplasty of the distal anastomosis which resulted in severe acute hemolysis. Despite only minim...

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Bibliographic Details
Published in:Vascular Medicine 2018-08, Vol.23 (4), p.400-406
Main Authors: Davison, Mark A, Norton, Derek M, Popoff, Andrew M, Seder, Christopher W, March, Robert J
Format: Article
Language:English
Subjects:
Anastomosis
Anemia
Aneurysm, Dissecting - diagnostic imaging
Aneurysm, Dissecting - surgery
Aneurysms
Aorta
Aortic Aneurysm, Thoracic - diagnostic imaging
Aortic Aneurysm, Thoracic - surgery
Aortic dissection
Blood Vessel Prosthesis Implantation - adverse effects
Case reports
Compression
Dacron
Deformation
Deformation mechanisms
Dissection
Grafting
Hemolysis
Hemolytic anemia
Humans
Kinking
Literature reviews
Magnetic Resonance Angiography
Male
Middle Aged
Repair
Stenosis
Surgery
Suture Techniques - adverse effects
Treatment Outcome
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Summary:A Dacron wrap aortoplasty has been described as an adjunct to reduction ascending aortoplasty for the repair of Type A aortic dissections. We report a case of an uncomplicated hemiarch repair with wrap aortoplasty of the distal anastomosis which resulted in severe acute hemolysis. Despite only minimal focal graft deformation on imaging, the patient was found to have a flow gradient across the distal anastomosis, which was reduced by > 50% following release of the outer graft wrap. To our knowledge, only 29 additional cases of hemolytic anemia following aortic dissection repair have been described in the English literature. The reported mechanisms included aortic graft stenosis (50%), graft kinking (23%), external compression of the graft (20%), and a folded elephant trunk appendage (7%). The mean onset of hemolysis following aortic dissection repair occurred 32.2 ± 44.4 months after surgery, with only 16.7% of cases occurring within 2 weeks. This review details the clinical, laboratory, and imaging findings suggestive of mechanical hemolysis following aortic surgery.
ISSN:1358-863X
1477-0377
DOI:10.1177/1358863X18776106