Unsuccessful aortic fenestration for aortic dissection complicated with mesenteric malperfusion analyzed using computational fluid dynamics: a case report.

General Thoracic and Cardiovascular Surgery Cases Pub Date : 2025-06-17 DOI:10.1186/s44215-025-00212-7

Shoki Iwanaga, Naoyuki Kimura, Shuta Imada, Mutsumi Mizoguchi, Mamoru Arakawa, Hirohiko Akutsu, Koji Kawahito, Masanori Nakamura

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Abstract

Background: We report a computational fluid dynamics (CFD)-based analysis of an unsuccessful open fenestration for aortic dissection with mesenteric malperfusion.

Case presentation: A 75-year-old male was admitted for acute type B aortic dissection complicated by mesenteric malperfusion. He had a concomitant infrarenal abdominal aneurysm, prompting surgical infrarenal fenestration. Intraoperatively, the proximal intimal flap was resected near the renal arteries, and the aneurysm was replaced with a prosthetic graft. Despite the intervention, mesenteric malperfusion worsened, requiring additional endovascular aortic repair. CFD analysis revealed persistent false lumen flow and true lumen compression due to a large entry tear and residual proximal anastomotic stenosis.

Conclusion: CFD analysis suggests that a large entry tear and residual stenosis from insufficient fenestration may result in inadequate false lumen depressurization.

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应用计算流体力学方法分析主动脉夹层开窗失败合并肠系膜灌注不良1例。

背景：我们报告了一项基于计算流体力学（CFD）的分析，分析了一例不成功的开窗治疗伴有肠系膜灌注不良的主动脉夹层。病例介绍：一名75岁男性因急性B型主动脉夹层合并肠系膜灌注不良而入院。他同时患有肾下腹腔动脉瘤，需要进行肾下开窗手术。术中，切除肾动脉附近的近端内膜皮瓣，并用假体移植物代替动脉瘤。尽管干预，肠系膜灌注不良恶化，需要额外的血管内主动脉修复。CFD分析显示，由于大的入口撕裂和残余的近端吻合口狭窄，持续的假管腔流动和真管腔压缩。结论：CFD分析表明，较大的入口撕裂和开窗不足导致的残余狭窄可能导致假腔减压不足。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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General Thoracic and Cardiovascular Surgery Cases

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