You are viewing the site in preview mode

Skip to main content
Download PDF

A case of simultaneous adrenalectomy and dissection repair with direct sheath placement into the aorta and systematic review of cases with hyperaldosteronism and vascular dissection: a case report

Journal of Medical Case Reports volume 19, Article number: 237 (2025) Cite this article

Abstract

Background

The incidence of acute aortic dissections is 3–6 patients per 100,000 in a year, with a high mortality rate of 40% at the initial diagnosis and increasing to 90% in an hour. There are several known risk factors for acute aortic dissection; however, the most common risk factor is systemic hypertension. Different conditions have been reported to be associated with resistant hypertension, including hyperaldosteronism.

Case presentation

A 57-year-old Persian man came to our clinic with occasional claudication after 30 m distance walking, left leg pain, and symptoms of chronic limb ischemia, including a cold left leg with a shiny appearance. He had a past medical history of recently diagnosed resistant hypertension and a past surgical history of a femoropopliteal bypass and a balloon angioplasty. His computed tomography angiography of the abdominopelvic cavity and lower limbs revealed a dissection of the infrarenal aorta at the bifurcation of common iliac arteries, occlusion of the left external iliac artery, and dissection of the left common iliac artery. In addition, a mass measuring 6 cm × 5 cm × 2 cm was identified in the patient’s left adrenal gland. The ostium of the false lumen was in the distal part of dissection so we decided to use an antegrade approach to repair the dissection. He underwent simultaneous surgeries for aneurysmal repair and adrenalectomy.

Conclusion

A vast systematic search of literature in Scopus, Web of Science, PubMed, and Google Scholar was carried out to identify cases of hyperaldosteronism relating to vascular dissection that were either treated with surgery or medication. Our results support the theory suggesting that hyperaldosteronism can be considered a risk factor for vascular dissection despite its effects on hypertension.

Peer Review reports

Introduction

Acute aortic dissection (AAD) is a rare disease with an incidence of 3–6 patients per 100,000 per year and a mortality rate of 40% at the initial diagnosis, which increases up to 90% after 1 hour of diagnosis. It is assumed to be underestimated owing to the 49% pre-hospitalization death rate of individuals with AADs [1, 2]. There are various recognized risk factors for this rare disease. Still, the most frequent risk factor is systemic hypertension (HTN), especially resistant HTN (RHTN), which has a frequency of 45–100% in individuals diagnosed with AAD [1, 3]. RHTN is defined as blood pressure (BP) that stays over the target objective despite administering three or more antihypertensive pharmacological agents at their optimal therapeutic dosage, one of which is a diuretic [4]. Different conditions have been reported to have an association with RHTN, including obstructive sleep apnea and hyperaldosteronism (HA) [5].

Primary hyperaldosteronism (PHA) prevalence has been reported differently in several studies, with rates up to 11% in patients with HTN [6]. PHA is more frequent in RHTN cases, with a prevalence of about 29% [7]. PHA is mostly caused by pathological events in adrenal glands, including adenomas, carcinomas, and hyperplasia [8]. According to recent studies, PHA-caused HTN may lead to greater end-organ damage and heighten the risk of cardiovascular events in comparison with essential HTN (including left ventricular hypertrophy, myocardial infarction, and atrial fibrillation), cerebrovascular incidences, aortic ectasia, arterial wall thickening, and metabolic syndrome [7, 9, 10]. However, owing to the rarity of vascular dissection, few cases have reported dissection following PHA. Here we present a case of abdominal AAD (infrarenal aorta) and common iliac artery (CIA) dissection associated with RHTN caused by an adrenocortical adenoma treated by simultaneous surgeries to address the adrenal adenoma and dissection. Further, a systematic review of current studies was performed to find related studies on this topic.

Case presentation

A 57-year-old Persian man came to our clinic with occasional claudication after 30 m distance walking, left leg pain, and symptoms of chronic limb ischemia, including a cold left leg with a shiny appearance for about 2 months. He had a past medical history of recently diagnosed RHTN (about 6 months before) that was not responsive to valsartan 320 mg, amlodipine 10 mg, hydrochlorothiazide 50 mg, and spironolactone 100 mg. He was a heavy smoker in the past, but he quit about 6 months before presentation (30 pack year). He had a past surgical history of a left femoropopliteal bypass about 15 years ago and a balloon angioplasty 11 years ago at the site of his previous bypass. The patient’s first physical examination showed no pulses in the left femoral artery, and the limb was cold to touch. He was immediately hospitalized for surgical intervention. His vital signs were BP 180/109 mmHg, pulse 80 beats per minute (bpm), respiratory rate 18 breaths per minute, and body temperature of 36.5 °C at the initial evaluation. His laboratory tests showed hemoglobin of 11.6 g/dl, blood urea nitrogen of 17 mg/dL, creatinine of 1.4 mg/dL, and potassium of 3.6 mEq/L. Laboratory data of the patient are presented in Table 1.

Table 1 Preoperation and postoperation laboratory data of our case
Full size table

His computed tomography angiography (CTA) of abdominopelvic cavity and lower limbs revealed a dissection of the infrarenal aorta at bifurcation of CIA (Stanford type B and De Bakey III), occlusion of the left external iliac artery (EIA), and dissection of the left CIA. In addition, a mass measuring 6 cm × 5 cm × 2 cm was identified in the patient’s left adrenal gland, indicative of an adrenal adenoma, considering his RHTN. Owing to the contrast given to the patient for CTA and his creatinine level, N-acetylcysteine 600 mg every 12 hours and intravenous dextrose saline was started for him about 24 hours before surgery and continued for 24 hours after operation.

A midline incision was made to enter the abdominal cavity, after which the right medial viscera were rotated to expose and remove the left adrenal mass. Subsequently, the infrarenal aorta was explored, and a 7 Fr introducer endovascular sheath was inserted antegrade for digital aortoiliac angiography directly on the aorta. The antegrade approach was used owing to the distal location of the false lumen ostium. As shown in the additional video (additional file), CTA demonstrated that the false-lumen opening was positioned in the distalmost part of the false lumen. To address the issues, we retrogradely punctured the right common femoral artery (CFA) and inserted a 6 Fr sheath, passing a hydrophilic guidewire with a JR catheter from both the right CFA sheath and aortic sheath. Stenting angioplasty of the left and right CIAs was performed simultaneously, utilizing a 9 mm × 38 mm stent graft in the left CIA and a 9 mm × 28 mm bared self-expandable stent in the right CIA. Finally, Hemovac and Nelaton drains were inserted into the abdominal cavity. He was given clopidogrel 450 mg stat, a full dose of low molecular-weight heparin every 12 hours, and cefazolin 1 gr stat and 1 gr every 8 hours (Figs. 1, 2).

Fig. 1
figure 1

Angiography of the abdominal aorta showing infrarenal aorta introducer sheath and a guidewire from left femoral access

Full size image
Fig. 2
figure 2

Adrenal adenoma of the patient

Full size image

The patient was admitted to the vascular surgery intensive care unit (ICU) and stayed there for 3 days before being transferred to the surgical ward. In the ICU, owing to a large amount of oozing (about 2 mL from the surgical site into the Hemovac and Nelaton drains), and owing to a fall in hemoglobin (Hb of 7.9 g/dL), two packs of red blood cells were transfused. Heparin was immediately discontinued, and rivaroxaban was started for him the next day. Then, after 24 hours of observation in the ICU, he was transferred to the ward. He was discharged after 3 days in the surgical ward. The patient’s blood pressure was within the normal range without any need for antihypertensive drugs. His overall health was excellent, and the previously nonpalpable left femoral pulse was now detectable on discharge. He was discharged with aspirin 80 mg daily, clopidogrel 75 mg daily for 6 months, rivaroxaban 15 mg daily, and atorvastatin 40 mg daily. A follow-up appointment for him was scheduled 1 month later. On the first visit after discharge, he had a normal color Doppler sonography of his left leg, bilateral femoral and distal pulses were detectable, and claudication did not appear after 500 m of walking. The pathology report revealed that the mass removed was an adrenocortical adenoma measuring 6 cm × 5 cm × 2 cm, which was confirmed by the immunohistochemistry study report (positive for CD56, INHIBIN, SYNAPTOPHYSIN, and VIMENTIN). During his next follow-up after 4 months of surgery, the patient’s general condition was good. Moreover, serum electrolyte levels and BP were normal.

Discussion

We present a case of infrarenal aorta and left CIA dissections with the accidental finding of an adrenal adenoma. The patient was recently diagnosed with RHTN and had a history of previous endovascular interventions, both of which are considered risk factors for vascular dissections [11]. It is most likely that the dissections occurred due to RHTN that could not be controlled with four combination drug therapies. The possibility of secondary causes of RHTN was taken into account and was confirmed with the finding of a left-side adrenal adenoma in CTA. Primary aldosteronism diagnostic tests are generally conducted after 3 weeks of discontinuation of antihypertensive drugs [12]. Diagnostic measurements and modalities for adrenal adenomas include:

  • Anatomical studies, including abdominal computed tomography, magnetic resonance imaging, and ultrasonography

  • Measures of serum plasma aldosterone-to-renin ratio

  • Adrenocortical scintigraphy

  • Saline confirmatory suppression test of aldosterone

  • Adrenal vein sampling for confirmation of aldosterone secretion [13]

In this case, owing to the emergent need for surgical intervention and the need for 3-week intervals to perform diagnostic measurements for adrenocortical-producing adenoma, no further preoperative biochemical tests were performed.

There are different options in the treatment of iliac artery dissection, including classical surgical treatment, endovascular treatment, and conservative treatment [14]. The CFA has been known as a primary access point for endovascular procedures [15]. In endovascular treatment, vascular access from the contralateral retrograde approach is considered risky [16]. To reduce the risk of intervention for patients, alternative access points have been reported, including trans-radial, transtibial, and sheath insertion directly to the aorta [17,18,19]. Owing to the unusual false lumen opening in our case, the retrograde endovascular approach had a risk of entering into the false lumen, so an alternative approach was performed for angiography.

A vast systematic search of literature in Scopus, Web of Science, PubMed, and Google Scholar was carried out to identify cases of PHA relating to vascular dissection (VD) that were either treated with surgery or medication. Moreover, the references of the included articles were searched to find any relevant studies. Keywords of the search were “vascular dissection” and “hyperaldosteronism.” The detailed search strategy is reported in the additional file. All references were screened manually by two authors (A.Ka. and A.K.) to identify relative cases. The reason for the exclusion of each study is also reported in the additional file. The search flow diagram of the included studies is shown in Fig. 3, and 24 articles were included [20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43]. The locations of VD of the patients were as follows: 18 cases had aortic dissections, 3 cases had vertebral artery dissections, 1 case had renal artery dissections, 1 case had splenic artery, right CIA, and renal artery dissections simultaneously, and 1 case had inferior vena cava with left renal vein dissections. In these cases, 16 of them had adrenal adenomas, 3 had hypersecretion of aldosterone, 2 had carcinomatous lesions, and 1 had a metastatic lesion. In addition, 15 cases of VD were treated with a surgical approach, of which 4 cases underwent surgery simultaneously for treatment. The mean age of VD was 46.21 ± 13.64 years and in PHA it was 45.7 ± 14.18 years. On the basis of our search, there are four cases of simultaneous surgery for both VD and PHA management—two of them underwent open surgery, one underwent an endovascular approach for both conditions, and the last case was a pregnant woman who underwent both endovascular for VD and an open-surgical approach for PHA during which a cesarean section was performed as well. Performing simultaneous surgery for these patients resulted in an uneventful postoperation outcome, and no significant complications were reported. The characteristics of the included studies are reported in Table 2.

Fig. 3
figure 3

Flow diagram of the screened studies

Full size image
Table 2 Characteristics of the included studies
Full size table

On the basis of Zhou et al.’s [44] review, there are several risk factors for aortic dissections categorized into general risk factors, modifiable risk factors, and aortic dimension. In general risk factors, male sex is more likely to develop AAD. Pregnancy, genetic variants, bicuspid aortic valve, geography, and ancestry are other risk factors. In modifiable risk factors, hypertension, dyslipidemia, aortitis, obstructive sleep apnea, fluoroquinolone, cocaine, weightlifting, and trauma can make the patient susceptible to AAD. Other risk factors in the aortic dimension category include dilatation (circumferential enlargement) and elongation (longitudinal enlargement) [44].

Studies have shown that PHA causes complications in the cardiovascular system that include increased risk of heart failure, ischemic heart disease, arterial stiffness, atrial fibrillation, and pulmonary arterial HTN. It is important to note that HTN derived from PHA was reported to have more cardiovascular effects than essential HTN [6, 7, 10, 45]. However, our systematic search revealed that there are few studies on the potential role of HA in aortic dissection. Few animal studies were performed to find out if this relation exists. Liu et al. [46] demonstrated that aldosterone injection can cause abdominal and aortic aneurysms and dissection. Moreover, they showed that mineralocorticoid receptor blockade prevents aneurysm and dissection in their mice. After that, Zhu et al., [47] in their case–control study on the Chinese population, showed that patients with higher aldosterone levels have significantly increased odds of aortic aneurysm and dissection. However, according to the small sample size and lack of cohort studies, the causality of this association is not approved. Our systematic review once again emphasizes the potential role of HA in aortic dissection and showed that 11 cases had only HA and HTN as the risk factors for the dissection. This case report and systematic review of cases call for more case–control or retrospective cohort studies to find the potential correlation between HA and vascular dissection.

Depending on the location of the VD, the choice to manage the condition with either medical treatment or surgical techniques is different [14, 48,49,50,51]. In aortic dissections, the management is mostly based on the location of the pathological event [52]. There are different classifications for aortic dissections, and mostly Stanford classification is used in the management of aortic dissection owing to its simplicity [53]. Any involvement of the ascending aorta is classified as type A Stanford, and type B is any dissection that excludes the ascending aorta [54]. Type A is considered a surgical emergency whereas type B is mostly treated with aggressive medical therapy, and in complicated cases, surgical or endovascular techniques are used [54]. The main goal in management is to reduce stress on the dissected aorta by controlling blood pressure (below 120/80 mmHg) and cardiac contractility in the acute phase of the disease [49, 55].

The prognosis and outcome of the patients who underwent surgery for both conditions were promptly better than those who underwent surgery for dissection and medical therapy for PHA based on our search results presented in Table 3. The need for postoperative medical therapy for blood pressure control and HA symptoms was less in the individuals who had undergone surgery for both conditions in comparison with patients who had medical therapy either for one condition or both. In one of the cases, medical therapy for PHA resulted in the death of the patient [37]. Moreover, two patients with medical treatment of PHA had a recurrence of aortic dissection after a few years [26, 36]. In contrast, we could not find any patients with surgical treatment of PHA with recurrence of vascular dissection. However, it is important to note that one of the common complications after adrenalectomy is adrenal insufficiency, which occurred in one of the cases in this review. We suggest that in situations where patients present with VD and have PHA, surgical management is likely to have a better prognosis and may reduce the risk of vascular dissection recurrence. Moreover, simultaneous surgery has been shown to have uneventful results and potentially may be more economically and psychologically beneficial for patients because they did not undergo surgery twice.

Table 3 Duration of follow-up and the outcome or prognosis of our cases
Full size table

Conclusion

Our case report and systematic review showed two different conclusions. First, in patients with an adrenal adenoma and aortic dissection, surgical treatment of PHA has a better prognosis and reduces the risk of vascular dissection recurrence. Moreover, simultaneous surgical treatment of the PHA etiology and the dissection showed uneventful results; therefore, surgeons can consider simultaneous surgery of the adrenal adenoma and aortic dissection. Moreover, our results support the theory suggesting that HA can be considered a risk factor for VD. Finally, we suggest performing more case–control and cohort studies to find more evidence about this correlation and the potential causality of HA on vascular dissection.

Availability of data and materials

Information about the patients can be requested from the authors. Do not hesitate to get in touch with the corresponding author if interested in the data.

Abbreviations

AAD:

Acute aortic dissections

HTN:

Hypertension

HA:

Hyperaldosteronism

CTA:

Computed tomography angiography

EIA:

Left external iliac artery

VD:

Vascular dissection

RHTN:

Especially resistant HTN

PHA:

Primary hyperaldosteronism

CIA:

Common iliac artery

CFA:

Common femoral artery

BP:

Blood pressure

References

  1. Howard D. Extra-coronary arterial disease: incidence, projected future burden, risk factors and prevention. UK: Oxford University; 2013.

    Google Scholar 

  2. Klompas M. Does this patient have an acute thoracic aortic dissection? JAMA. 2002;287(17):2262–72.

    Article  PubMed  Google Scholar 

  3. Pape LA, Awais M, Woznicki EM, Suzuki T, Trimarchi S, Evangelista A, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection. J Am Coll Cardiol. 2015;66(4):350–8.

    Article  PubMed  Google Scholar 

  4. DA C. American Heart Association Professional Education Committee. Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation. 2008;117:e510–e26.

  5. Calhoun DA, Nishizaka MK, Zaman MA, Thakkar RB, Weissmann P. Hyperaldosteronism among Black and white subjects with resistant hypertension. Hypertension. 2002;40(6):892–6.

    Article  PubMed  CAS  Google Scholar 

  6. Monticone S, Burrello J, Tizzani D, Bertello C, Viola A, Buffolo F, et al. Prevalence and clinical manifestations of primary aldosteronism encountered in primary care practice. J Am Coll Cardiol. 2017;69(14):1811–20.

    Article  PubMed  Google Scholar 

  7. Parasiliti-Caprino M, Lopez C, Prencipe N, Lucatello B, Settanni F, Giraudo G, et al. Prevalence of primary aldosteronism and association with cardiovascular complications in patients with resistant and refractory hypertension. J Hypertens. 2020;38(9):1841–8.

    Article  PubMed  CAS  Google Scholar 

  8. Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2016;101(5):1889–916.

    Article  PubMed  CAS  Google Scholar 

  9. Monticone S, D’Ascenzo F, Moretti C, Williams TA, Veglio F, Gaita F, et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2018;6(1):41–50.

    Article  PubMed  CAS  Google Scholar 

  10. Murata M, Kitamura T, Tamada D, Mukai K, Kurebayashi S, Yamamoto T, et al. Plasma aldosterone level within the normal range is less associated with cardiovascular and cerebrovascular risk in primary aldosteronism. J Hypertens. 2017;35(5):1079–85.

    Article  PubMed  CAS  Google Scholar 

  11. Malcic-Gürbüz J, Akalin A, Gümüşcü B, Cavdar S. Clinical implications of concomitant variations of the testicular, suprarenal and renal veins: a case report. Ann Anat. 2002;184(1):35–9.

    Article  PubMed  Google Scholar 

  12. Mulatero P, Bertello C, Garrone C, Rossato D, Mengozzi G, Verhovez A, et al. Captopril test can give misleading results in patients with suspect primary aldosteronism. Hypertension. 2007;50(2):e26–7.

    Article  PubMed  CAS  Google Scholar 

  13. Mattsson C, Young WF Jr. Primary aldosteronism: diagnostic and treatment strategies. Nat Clin Pract Nephrol. 2006;2(4):198–208.

    Article  PubMed  CAS  Google Scholar 

  14. Zha B, Zhu H, Liu B, Ye Y, Li J. Preservation of internal iliac artery after endovascular repair of common iliac artery dissection using modified fenestrated stent graft. Korean Circul J. 2016;46(3):412.

    Article  Google Scholar 

  15. Seto AH, Abu-Fadel MS, Sparling JM, Zacharias SJ, Daly TS, Harrison AT, et al. Real-time ultrasound guidance facilitates femoral arterial access and reduces vascular complications: FAUST (Femoral Arterial Access With Ultrasound Trial). JACC Cardiovasc Intervent. 2010;3(7):751–8.

    Article  Google Scholar 

  16. Sevil FC, Tort M. Management of endovascular treatment in spontaneous iliac artery dissections: applications enabling classical surgery. Turkish J Thorac Cardiovasc Surg. 2020;28(4):601.

    Article  Google Scholar 

  17. Carpenter JP. Delivery of endovascular grafts by direct sheath placement into the aorta or iliac arteries. Ann Vasc Surg. 2002;16(6):787–90.

    Article  PubMed  Google Scholar 

  18. Ahsan MJ, Ahmad S, Latif A, Lateef N, Ahsan MZ, Abusnina W, et al. Transradial versus transfemoral approach for percutaneous coronary intervention in patients with ST-elevation myocardial infarction complicated by cardiogenic shock: a systematic review and meta-analysis. Eur Heart J Qual Care Clin Outcomes. 2022;8(6):640–50.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Tokutake D, Miyauchi E, Arikawa R, Oketani N, Ohishi M. Successful endovascular therapy using the transtibial approach in a patient with a history of iliofemoral and femorofemoral surgical bypass. Cureus. 2023;15(6).

  20. Ahmed SH, Husain NM, Khawaja SN, Massey CV, Pettyjohn FS. Is primary hyperaldosteronism a risk factor for aortic dissection? Cardiology. 2007;108(1):48–50.

    Article  PubMed  Google Scholar 

  21. Bhatty TAN, Chaudhry QS, Khan Z, Bastawicy AN. Leaking abdominal aortic aneurysm mimicking ureteric colic: so rare but so real in Middle East. Urol Ann. 2017;9(2):192–3.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Harvey K, Riga C, O’Connor M, Hamady M, Chapman N, Gibbs R. A rare case of aortic dissection and primary hyperaldosteronism. Ejves Extra. 2010;20(3):e22–4.

    Article  Google Scholar 

  23. Hirai H, Shibata T, Sasaki Y, Fujii H, Kubo S, Suehiro S. Simultaneous surgery for chronic aortic dissection and adrenal adenoma with primary aldosteronism. Gen Thorac Cardiovasc Surg. 2010;58:235–8.

    Article  PubMed  Google Scholar 

  24. Ilie I, Vouillarmet J, Decaussin-Petrucci M, Jeannin-Mayer S, Lifante J-C, Thivolet C, et al. Bilateral vertebral artery dissection revealing Cushing’s syndrome. Ann Endocrinol. 2019;80:67.

    Article  Google Scholar 

  25. Inaba H, Kaido Y, Kosugi D, Asai Y, Ogino S, Nakano S, et al. Pheochromocytoma multisystem crisis complicated by severe acute pancreatitis. Intern Med. 2023;62(13):1957–63.

    Article  PubMed  Google Scholar 

  26. Ito Y, Yoshimura K, Matsuzawa Y, Saito J, Ito H, Furukawa H, et al. Successful treatment of a mycotic aortic pseudoaneurysm in a patient with type 2 diabetes mellitus while treating primary aldosteronism with spironolactone. J Atheroscler Thromb. 2010;17(7):771–5.

    Article  PubMed  Google Scholar 

  27. Jin HY, Lee KA. Primary hyperaldosteronism: a rare cause of acute aortic dissection. Korean J Intern Med. 2021;36(2):477–8.

    Article  PubMed  Google Scholar 

  28. Kato M, Tanaka Y, Kuroda T, Nakashima T, Hattori T. Vertebral artery dissecting aneurysm with Cushing’s syndrome—Case report. Neurol Med Chir. 2010;50(4):313–5.

    Article  Google Scholar 

  29. Kiriakopoulos A, Papaioannou D, Linos D. Adrenal cortical oncocytoma mimicking pheochromocytoma. Hormones (Athens). 2011;10(1):76–9.

    Article  PubMed  Google Scholar 

  30. Lam K-Y, Lo C-Y. The clinicopathologic significance of unilateral adrenal cortical hyperplasia: report of an unusual case and a review of the literature. Endocr Pathol. 1999;10:243–9.

    Article  PubMed  Google Scholar 

  31. Malinowski AK, Maxwell C, Sermer M, Rubin B, Gandhi S, Silversides CK. Pheochromocytoma in a pregnant woman with prior traumatic aortic injury. Obstet Gynecol. 2015;126(5):1089–94.

    Article  PubMed  Google Scholar 

  32. Njami VA, Dulguerov F, Zingg T, Kirsch M. Type A aortic dissection and pheochromocytoma: an indirect consequence of the Covid-19 pandemic. Eur J Cardio-Thoracic Surg. 2022;62(5):477.

    Article  Google Scholar 

  33. Petramala L, Cotesta D, Sapienza P, Zinnamosca L, Moroni E, di Marzio L, et al. A case of acute aortic dissection type B associated with Cushing’s syndrome. J Clin Med Res. 2009;1(1):50.

    PubMed  PubMed Central  Google Scholar 

  34. Safi AM, Kwan T, Afflu E, Alam M, Anderson JE, Clark LT. Coronary artery aneurysms, aortic dissection, and hypertension secondary to primary aldosteronism: a rare triad: a case report. Angiology. 1999;50(6):503–8.

    Article  PubMed  CAS  Google Scholar 

  35. Sarlon G, Silhol F, Vaïsse B. Coexisting renal artery aneurysm and adrenal adenoma in resistant hypertension. Arch Cardiovasc Dis. 2011;104(5):363–4.

    Article  PubMed  Google Scholar 

  36. Shahrrava A, Moinuddin S, Boddu P, Shah R. A case of glucocorticoid remediable aldosteronism and thoracoabdominal aneurysms. Case Rep Endocrinol. 2016;2016:2017571.

    PubMed  PubMed Central  Google Scholar 

  37. Shimizu A, Aoi W, Akahoshi M, Utsunomiya T, Doi Y, Suzuki S, et al. Elevation of plasma renin activity during pregnancy and rupture of a dissecting aortic aneurysm in a patient with primary aldosteronism. Japan Heart J. 1983;24(6):995–1006.

    Article  CAS  Google Scholar 

  38. Takagi C, Ashizawa N, Eishi K, Ashizawa K, Hayashi T, Tanaka K, et al. Segmental mediolytic arteriopathy involving celiac to splenic and left renal arteries. Intern Med. 2003;42(9):818–23.

    Article  PubMed  Google Scholar 

  39. Thompson J, Clifford P, McEwan J, Chant A. Phaeochromocytoma and abdominal aneurysm: confirmation of diagnosis after aortic surgery using mIBG imaging. Eur J Vasc Surg. 1989;3(5):457–9.

    Article  PubMed  CAS  Google Scholar 

  40. Yamasaki M, Yamamoto K, Abe K, Nakamura R, Tamaki R, Misumi H. Aortic dissection due to primary aldosteronism in a young adult with adrenal adenoma: a case report. J Cardiol Cases. 2022;26(2):154–6.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Zhang Y, Luo F, Fan P, Meng X, Yang K, Zhou X. Is primary aldosteronism a potential risk factor for aortic dissection? A case report and literature review. BMC Endocr Disord. 2020;20(1):115.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  42. Puwanant S, Click RL, Kalra M, Farley DR, Chandrasekaran K. Incidental detection of inferior vena caval dissection by intraoperative high frequency vascular duplex ultrasonography. Echocardiography. 2007;24(3):269–71.

    Article  PubMed  Google Scholar 

  43. Tsuchida R, Kasahara N, Inobe M, Terado Y, Horita A, Yokoyama K, et al. Aortic intramural hematoma associated with metastatic carcinoma. Pathol Res Pract. 2010;206(12):839–45.

    Article  PubMed  Google Scholar 

  44. Zhou Z, Cecchi AC, Prakash SK, Milewicz DM. Risk factors for thoracic aortic dissection. Genes (Basel). 2022;13(10):1814.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  45. Wang W-T, Wu T-H, Er L-K, Huang C-W, Tu K-H, Fan K-C, et al. Recent progress in unraveling cardiovascular complications associated with primary aldosteronism: a succinct review. Hypertens Res. 2024:1–17.

  46. Liu S, Xie Z, Daugherty A, Cassis LA, Pearson KJ, Gong MC, et al. Mineralocorticoid receptor agonists induce mouse aortic aneurysm formation and rupture in the presence of high salt. Arterioscler Thromb Vasc Biol. 2013;33(7):1568–79.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Zhu Q, Heizhati M, Lin M, Wang M, Yao X, Gan L, et al. Higher plasma aldosterone concentrations are associated with elevated risk of aortic dissection and aneurysm: a case–control study. Hypertension. 2022;79(4):736–46.

    Article  PubMed  CAS  Google Scholar 

  48. Sorber R, Hicks CW. Diagnosis and management of acute aortic syndromes: dissection, penetrating aortic ulcer, and intramural hematoma. Curr Cardiol Rep. 2022;24(3):209–16.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Rylski B, Schilling O, Czerny M. Acute aortic dissection: evidence, uncertainties, and future therapies. Eur Heart J. 2023;44(10):813–21.

    Article  PubMed  Google Scholar 

  50. Qiu C, Wu Z, He Y, Tian L, Zhu Q, Shang T, et al. Endovascular therapy versus medical treatment for spontaneous isolated dissection of the superior mesenteric artery. Cochrane Database Syst Rev. 2022(9).

  51. Peng J, Liu Z, Luo C, Chen L, Hou X, Xiao L, et al. Treatment of cervical artery dissection: antithrombotics, thrombolysis, and endovascular therapy. Biomed Res Int. 2017;2017(1):3072098.

    PubMed  PubMed Central  Google Scholar 

  52. De Bakey ME, Henly WS, Cooley DA, Morris GC Jr, Crawford ES, Beall AC Jr. Surgical management of dissecting aneurysms of the aorta. J Thorac Cardiovasc Surg. 1965;49(1):130–49.

    Article  Google Scholar 

  53. Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE. Management of acute aortic dissections. Ann Thorac Surg. 1970;10(3):237–47.

    Article  PubMed  CAS  Google Scholar 

  54. Members WG, Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010;121(13):e266–369.

    Google Scholar 

  55. Erbel R, Aboyans V, Boileau C, Bossone E, Di Bartolomeo R, Eggebrecht H, et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases. Kardiol Polska (Polish Heart J). 2014;72(12):1169–252.

    Article  Google Scholar 

  56. Sanga V, Lenzini L, Seccia TM, Rossi GP. Familial hyperaldosteronism type 1 and pregnancy: successful treatment with low dose dexamethasone. Blood Press. 2021;30(2):133–7.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the patient for their cooperation in the current article.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Surgery, School of Medicine, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

    Meghdad Ghasemi Gorji

  2. Research Center for Noncommunicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran

    Alireza Keshtkar

  3. Department of Vascular Surgery, Shiraz University of Medical Science, Shiraz, Iran

    Ali Rafiei, Parsa Yazdanpanahi & Alireza Karimi

Authors
  1. Meghdad Ghasemi Gorji
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Alireza Keshtkar
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Ali Rafiei
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Parsa Yazdanpanahi
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Alireza Karimi
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

AK and AKa were responsible for screening and data extraction. AK, AKa, PY, and AR wrote the manuscript. MGG designed the study and revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Alireza Karimi.

Ethics declarations

Ethics approval and consent to participate

The patient signed a written informed consent.

Consent for publication

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gorji, M.G., Keshtkar, A., Rafiei, A. et al. A case of simultaneous adrenalectomy and dissection repair with direct sheath placement into the aorta and systematic review of cases with hyperaldosteronism and vascular dissection: a case report. J Med Case Reports 19, 237 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13256-025-05276-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13256-025-05276-1

Keywords

Journal of Medical Case Reports

ISSN: 1752-1947