CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 6, July 2013
AFRICA
e1
Case Report
New vascular ring connectors in surgery for intramural
haematoma of the abdominal aorta progressing to rupture
CHIH-HSIEN LEE, LI-WEI KO, YI-CHANG LIN, CHIH-CHIEN YEN, HSIANG-YU YANG, CHIH-HONG KAO,
CHIEN-SUNG TSAI, YI-TING TSAI
Abstract
Aortic intramural haematoma is similar to classic aortic
dissection, which causes a life-threatening medical condi-
tion, and immediate diagnosis and treatment are crucial.
The optimal therapy for intramural haematoma of the
abdominal aorta remains controversial. Conservative medi-
cal management is usually the first choice of treatment
for uncomplicated cases. Surgical intervention is usually
required for complicated intramural haematomas of the
abdominal aorta, including conventional open repair and
endovascular treatment with stent-grafts. A new vascular
ring connector that achieves a quick, blood-sealed and
sutureless anastomosis has been designed for aortic dissec-
tion. We herein report a case of intramural haematoma of
the abdominal aorta, progressing to rupture on day 14 after
onset, which had successful aortic repair with the new vascu-
lar ring connector. The new vascular ring connector could
be an alternative method for the treatment of complicated
intramural haematomas of the abdominal aorta.
Keywords:
aortic dissection, intramural haematoma, vascular
ring connector
Submitted 3/4/12, accepted 19/6/13
Cardiovasc J Afr
2013;
24
: e1–e3
DOI: 10.5830/CVJA-2013-049
Aortic intramural haematoma (IMH) develops as a result of
spontaneous rupture of the vasa vasorum of the aorta or rupture
of an atherosclerotic plaque.
1
Conservative medical management
is usually the first choice of treatment for Stanford type B acute
aortic dissection without complications.
IMH has been recommended to be managed according
to the same guidelines as classic dissection.
2
However, IMH
evolves very dynamically in the short term to regression,
classic dissection, or aortic rupture.
1
Surgical intervention is
usually required for complicated intramural haematomas of
the abdominal aorta, including conventional open repair and
endovascular treatment with stent-grafts.
A new vascular ring connector (Vasoring, Sunwei Technology
Co, Taipei, Taiwan) has been designed for aortic dissection.
3
It
is a titanium ring that is used as a stent in the vascular graft to
achieve a quick, blood-sealed and sutureless anastomosis. We
herein report a case of intramural haematoma of the abdominal
aorta, progressing to rupture on day 14 after onset, which was
successfully surgically repaired with the new vascular ring
connector.
Case report
A 49-year-old man with a past history of hypertension without
regular medical control presented to our hospital with acute,
intense epigastric and back pain for six hours. On admission, his
blood pressure was 180/110 mmHg and pulse rate was 78 beats
per minute. Physical examination of the chest and abdomen
showed no signs of visceral ischaemia. Peripheral arterial pulses
were easily palpable in the upper and lower extremities.
Laboratory data were unremarkable. Initial contrast-enhanced
computed tomography (CT) showed a focal wall thickening
from the descending aorta to the left common iliac artery without
a demonstrable intimal flap or false lumen. On suspicion of an
intramural haematoma of the abdominal aorta, the patient was
admitted to the medical intensive care unit for blood pressure
control and further evaluation.
On day 14 after onset, the patient complained of recurrent
refractory abdominal pain. Physical examination of the abdomen
revealed intractable tenderness and normal bowel sounds.
Arterial pulsations in both lower limbs were palpable. A follow-
up contrast-enhanced CT (Fig. 1) showed aortic dissection
with a large primary entry tear in the infra-renal section of
the abdominal aorta, extending to the bifurcation of the distal
abdominal aorta.
The patient received emergency open surgery with the
traditional open procedure before anastomosis. We used a
Department of Cardiac Surgery, Tungs’ Taichung Metro-
Harbor Hospital, Taipei, Taiwan
CHIH-HSIEN LEE, MD
Department of Biological Science and Technology, National
ChiaoTung University, Taipei, Taiwan
CHIH-HSIEN LEE, MD
LI-WEI KO, PhD
Division of Cardiovascular Surgery, Department of Surgery,
Tri-Service General Hospital, National Defense Medical
Centre, Taipei, Taiwan
CHIH-HSIEN LEE, MD
YI-CHANG LIN, MD
CHIH-CHIEN YEN, MD
HSIANG-YU YANG, MD
CHIH-HONG KAO, MD
CHIEN-SUNG TSAI, MD
YI-TING TSAI, MD,
