As some of you know, I recently accepted a position in the Section of Vascular Surgery and Endovascular Therapy at the University of Chicago Medicine. One of my major administrative responsibilities is co-directing the University of Chicago Center for Aortic Diseases (UCCAD – www.ucaorta.org) with Mark Russo, MD, MSc. We have assembled a group of physicians that want to treat the most complex aortic diseases. We hope to establish ourselves as a regional and national center of excellence. Our group includes vascular surgery, cardiac surgery, interventional cardiology, general cardiology, interventional radiology, and anesthesiology/critical care. I think this case illustrates our mission and collaboration well.
We recently cared for a gentleman who underwent a type A aortic dissection repair approximately 5 years ago. He presented to another institution with chest pain and had an aortic pseudoaneurysm in the ascending aorta near the coronary arteries. We performed a diagnostic aortogram, IVUS of the aorta, and cardiac catheterization in the same sitting in the cath lab under the direction of Dr. Sandeep Nathan. A few days later, he underwent a multivessel coronary intervention by Dr. Nathan. He did well and returned 3 weeks later for an endovascular approach to this complex ascending aortic problem.
We treated him in the OR with Dr. Mark Chaney leading our anesthesia team and Dr. Roberto Lang assisting with his expertise in TEE. Dr. Russo and I successfully placed a stent in the ascending aorta with the protection of cardio-pulmonary bypass in case a coronary artery was inadvertently covered. In addition, Dr. Nathan scrubbed in to place a catheter at the origin of the left main to assist with identifying this vessel when we deployed the aortic extension cuff in the ascending aorta (Figures 1 and 2). The patient did very well and was discharged on POD #2 with this approach. A redo sternotomy would have carried a very high morbidity and mortality rate. This approach made a huge difference in outcome for this patient.
IVUS = intravascular ultrasound
TEE = transesophageal echocardiography
OR = operating room
POD #2 = Postoperative Day 2
ROSS MILNER, MD, FACS
Ross Milner, MD, FACS is associate professor of surgery in the section of vascular surgery and endovascular therapy, co-director of the Center for Aortic Diseases, and associate program director of the Vascular Surgery Fellowship at The University of Chicago Medicine & Biological Sciences.
Dr. Milner graduated Cum Laude from the University of Pennsylvania, where he also completed medical school. He was chief resident in surgery at the Hospital of the University of Pennsylvania. He completed fellowships at the University of Pennsylvania and University Medical Center in Utrecht in the Netherlands.