Page 6 - Virtual Vascular Vol 6

His infrarenal aorta and iliac vessels are very small in caliber, but there is no stenosis or
occlusion. Lower limb arteries are small but patent. This is probably the reason for his Marfan Chronic Dissection
cold legs. Management remains non surgical with conservatives measures to keep

warm, and to protect feet and ankles.
Entry tear

Short
prosthetic
graft

A 51 year man with Marfan Syndrome. Had a Type A dissection in 2006 treated with emergency
Bentall operation (Ascending aorta and aortic valve replacement). The entry tear in the arch was
not treated, and the residual chronic dissection extends into the iliacs. The thoracoabdominal
aorta is expanding but not yet reached repair threshold. He will most likely develop a full thoraco-
abdominal dissecting aneurysm in the future.

This type of short prosthetic ascending aortic replacement should be avoided if possible as this
makes future endovascular repair impossible due to inadequate proximal landing zone. The pa-

tient will likely require a redo sternotomy. Forward planning in emergency dissection repair is a
6 modern trend. 7