2026 FSA Podium and Poster Abstracts

Background: Aortic dissection is a life-threatening condition with significant perioperative implications that vary based on dissection type, chronicity, and end-organ involvement. While Stanford Type A dissections require urgent surgical intervention, chronic Type B dissections may be managed conservatively but pose unique anesthetic and hemodynamic challenges, particularly during non-aortic surgical procedures. Patients with connective tissue disorders such as Marfan syndrome are at increased risk for complex aortic pathology and multisystem involvement.

Case Presentation: We present a 57-year-old female with a complex medical history of Marfan syndrome, Addison’s disease on chronic steroid therapy, prior surgically repaired Type A aortic dissection, and residual chronic Type B dissection extending from the distal aortic arch to the iliac arteries. Imaging demonstrated a large false lumen supplying the renal arteries, with resultant left renal atrophy (Figure 1). The patient presented with symptoms of right heart failure and severe tricuspid regurgitation, likely secondary to a transvenous right ventricular defibrillator lead. After surgical consultation, extraction of the right ventricular lead with conversion to a subcutaneous implantable cardioverter-defibrillator was recommended. Given pacemaker dependence, extensive aortic disease, and high perioperative risk, multidisciplinary planning was essential. Anesthetic management included invasive arterial monitoring, stress-dose steroids, careful induction, and continuous intraoperative transesophageal echocardiography to monitor cardiac function and aortic pathology. The procedure was completed successfully with stable hemodynamics and no immediate complications.

Discussion: This case highlights the downstream consequences of chronic Type B aortic dissection, including false lumen perfusion and end-organ compromise, and underscores how these features influence perioperative decision-making. In patients with connective tissue disease, even non-aortic surgical interventions require meticulous anesthetic planning to mitigate risks of propagation, malperfusion, and hemodynamic instability.

Conclusion: Understanding the classification and physiologic consequences of aortic dissection is critical for safe perioperative management. This case emphasizes the importance of individualized care when managing patients with complex aortic pathology undergoing non-aortic surgery.