Cerebral oximetry for early diagnosis of intraoperative type A aortic dissection during endovascular aortic repair: a case report

A case was diagnosed with Stanford type A aortic dissection (TAAD) during endovascular aortic repair (EVAR), complicating with cardiac tamponade and asystole as a result. Intraoperative TAAD is rare but can be life threatening without prompt diagnosis and appropriate treatment. Its diagnosis requires highly clinical suspicion and appropriate diagnostic tools. However, its symptoms may be masked by general anesthesia, and the clinical presentation is often nonspecific. Thus, widely adopted screening tools, such as classic clinical triad of acute aortic dissection or aortic dissection detection risk score (ADD-RS), are not applicable for patients undergoing surgery, making a timely diagnosis of intraoperative TAAD challenging. Moreover, overuse of diagnostic tools can harm patients or interrupt the procedure. The use of perioperative monitoring tools, such as cerebral oximetry, may aid in establishing clinical suspicion and facilitate timely diagnosis for intraoperative TAAD. Routine use of cerebral oximetry can be considered for high-risk populations undergoing regular surgeries or surgeries with a high-risk of TAAD, such as EVAR.