Type 2 dissection of aorta with renal artery stenosis

[sue]

Last Wednesday (10/6/99) my father drove himself to the ER because of flank pain.  He was diagnosed with a Type 2 dissection of the aorta that started at midpoint of the aortic branch and went down past the renal arteries.  He was placed on Esmolol drip Nipride and Labatelol(?) to control his blood pressure.  He had a  respiratory arrest on Saturday due to sedation accumulation.  He was on a ventilator from Saturday until this past Tuesday.   Now they've discovered that he has moderate renal artery stenosis.  He has a history of hypertriglycerides for >20 years.  Could this have caused the renal artery stenosis or would the dissection have caused the stenosis?  We've been told that this can be managed medically, but how can it be managed medically?  Also, what is his likely prognosis?  We've been told that he will never be a surgical candidate, as the dissection is too extensive and he would probably not survive surgery.  Does this mean any surgery?

[CCF CARDIO MD - CRC]

Stenosis and dissection are sisters that run together and it is not uncommon to see both in the same patient.  There is probably no surgical indication for the dissection as the risks of the surgery outweigh the benefits.  The renal artery stenosis can be managed medically but may also be able to have a stent placed.  Probably the next step is to stabilize him medically and consider stenting after that.