Newly Developed Aortic Dissection in the Abdominal Aorta After Femoral Arterial Perfusion Kazumasa Orihashi, MD, Taijiro Sueda, MD, Kenji Okada, MD,

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Newly Developed Aortic Dissection in the Abdominal Aorta After Femoral Arterial Perfusion Kazumasa Orihashi, MD, Taijiro Sueda, MD, Kenji Okada, MD, Katsuhiko Imai, MD The Annals of Thoracic Surgery Volume 79, Issue 6, Pages 1945-1949 (June 2005) DOI: 10.1016/j.athoracsur.2005.01.005 Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Transesophageal echocardiogram demonstrating the malperfusion and new development of dissection in celiac artery (CEA) in case 2. (A) Before bypass. (B) During bypass; the CEA flow became undetectable. (C) After bypass; the CEA flow recovered but with dissection in the CEA and aorta (AO). Intimal flap is seen. (D) In the peripheral portion of CEA, dissection extends distally into the branch arteries. The Annals of Thoracic Surgery 2005 79, 1945-1949DOI: (10.1016/j.athoracsur.2005.01.005) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Computed tomogram after 7 years of surgery in case 2. (A) No dissection at the level of right renal artery. (B) Infrarenal aorta with dilated false lumen. (C) False lumen in the internal iliac artery has expanded. (D) Dissection in the left common iliac artery and aneurysm of right common iliac artery. The Annals of Thoracic Surgery 2005 79, 1945-1949DOI: (10.1016/j.athoracsur.2005.01.005) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Computed tomogram after 6 years of surgery in case 1. (A) New dissection is present at the level of superior mesenteric artery (SMA). (B) Infrarenal portion of aorta shows aneurysmal change (50 mm in diameter). The Annals of Thoracic Surgery 2005 79, 1945-1949DOI: (10.1016/j.athoracsur.2005.01.005) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Transesophageal echocardiogram demonstrating circumferential dissection in the abdominal aorta (AO) after cardiopulmonary bypass in case 11. The Annals of Thoracic Surgery 2005 79, 1945-1949DOI: (10.1016/j.athoracsur.2005.01.005) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Three-dimensionally reconstructed computed tomogram showing how intimal injury occurs by the jet stream from the arterial cannula (arrow) that is inserted into the femoral artery. The flow velocity of jet stream exceeds 2 m/s at the tip of cannula. The Annals of Thoracic Surgery 2005 79, 1945-1949DOI: (10.1016/j.athoracsur.2005.01.005) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions