Treatment of patients with chronic dissecting aortic aneurysm (DeBakey type IIIb) presenting with compromised renal perfusion

: We reviewed our experience for 6 patients of chronic dissecting aortic aneurysm (DeBakey type IIIb) with the false lumen extending into the abdominal aorta and the renal arteries being perfused from the false lumen. In three cases, whose abdominal aorta presenting with large aneurysmal lesions, we performed graft replacement of the thoracic descending aorta and abdominal aorta simultaneously. In other three cases, whose abdominal aorta presenting without aneurysmal lesions, and moreover age advanced or perioperative conditions poor, we performed graft replacement of thoracic descending aorta, using double barreled distal anastomosis technique to ensure of enough blood flow into both true and false lumens. All patients survived and there were no early postoperative complications. In 3 cases of thoracic aortic replacement alone, the mean follow-up term was 38 months, postoperative computed tomography showed neither apparent expansion of the false lumen nor compression of the true lumen of the abdominal aorta, and postoperative renal function were maintained. In conclusion, in treatment of chronic dissecting aortic aneurysm (DeBakey type IIIb) presenting with compromised renal perfusion, we considered that replacement of the thoracic descending aorta and abdominal aorta brings patient the most radical improvements. But in the patients, who are elder or in poor perioperative conditions, the replacement of thoracic descending aorta using double barreled distal anastomosis technique is one easier applicable and safer procedure to preserve the renal perfusion.