Unusual vascular complications of dissecting thoracic aortic aneurysms

Nondissecting, chronic, thoracic aortic aneurysms (TAA) may be associated with such vascular complications as aorto-cardiac, aorto-superior vena caval (SVC) and aorto-pulmonary arterial (PA) fistula formation, and/or SVC or PA compression. Dissecting TAA have been associated with these lesions far less often. This report summarizes the occurrence and outcome of the following complications of dissecting TAA: (1) SVC obstruction; (2) aortoright and-left atrial, aorta-right ventricular and aorto-PA fistula formation; (3) compression of the PA and (4) hematoma of the interatrial septum. Two patients are described with aortic dissection complicated by: (1) SVC obstruction and aorto-left atrial fistula; and (2) aorto-PA fistula. These complicttions are rarer with aortic dissection, because of the acute, catastrophic nature of this lesion. When dissection is chronic, however, arteriovenous fistulae are often well tolerated, and urgent surgical intervention seems to be unnecessary.