Double acute aortic syndrome in a patient with end-stage chronic kidney disease - Case Report and Literature Review

Abstract

Introduction: Cardiovascular diseases are the leading cause of mortality worldwide, with aortic dissection being one of the most serious conditions, associated with high mortality. According to the Stanford classification, dissections are grouped into type A, which involves the ascending aorta and requires immediate surgery, and type B, located distal to the left subclavian artery, for which treatment may be both medical and/or endovascular. End-stage chronic kidney disease, treated by hemodialysis, is a severe risk factor owing to treatment‑resistant hypertension, vascular calcifications, and systemic fragility.

Case presentation: We present the case of a 44-year-old patient with end-stage chronic kidney disease, dependent on hemodialysis for 14 years and with hypertension refractory to treatment, with a literature review. At the first admission, the initial CT angiography revealed an extensive Stanford type B dissection with severe vascular damage for which a hybrid procedure was performed: debranching of the supra-aortic vessels, followed by thoracic endovascular repair. Two months postoperatively, due to difficult-to-control hypertension, she was readmitted for a Stanford type A dissection, requiring a redo sternotomy, replacement of the ascending aorta with a Dacron graft and revascularization of the supra-aortic branches. Despite severe comorbidities and dialysis dependence, the patient survived both interventions and was discharged in stable condition.

Conclusions: Acute aortic dissection in dialysis-dependent patients is rare but carries exceptionally high mortality. The coexistence of end-stage renal disease, refractory hypertension, and vascular calcification increases diagnostic and therapeutic challenges. Hybrid or emergency surgical–endovascular approaches can be life-saving and multidisciplinary management with careful long-term follow-up are essential to optimize prognosis.