DOI: 10.11648/j.sr.20261404.19 ISSN: 2329-0927

A Case Report on the Treatment of Extensive Burn Complicated with Stanford Type B Aortic Dissection and Pulmonary Embolism

Mairepati Dilixiati, Cao Yu, Zheng Gang
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Objective: To explore the diagnostic and therapeutic strategies for a rare critical case of extensive burns complicated by Stanford Type B aortic dissection and pulmonary artery embolism, analyzing the principles for resolving treatment conflicts and clinical outcomes. Methods: A retrospective analysis was conducted on the clinical data of a 55-year-old male patient admitted in September 2024 with extensive burns and vascular complications. The patient presented with 71% total body surface area (TBSA) burns, comprising 55% third-degree and 16% second-degree burns, mainly complicated by Stanford Type B aortic dissection (chronic), distal right pulmonary artery trunk and branch embolism, and near-complete thrombosis of the left upper limb. Clinical characteristics, laboratory test dynamics, surgical approach, and anticoagulation strategy were analyzed. Results: Enhanced CT angiography confirmed the diagnosis upon admission. Addressing the treatment conflict between aortic dissection and pulmonary embolism, a strategy of “staged surgery + close monitoring + cautious low-molecular-weight heparin anticoagulation” was adopted. Specific measures: (1) Wound management: Underwent 6 surgical procedures including debridement and eschar removal, heterograft skin grafting, Meek grafting, and autograft skin grafting to progressively close the wound. (2) Aortic dissection management: Control blood pressure (target systolic 100–130 mmHg; 1 mmHg = 0.133 kPa) and heart rate (target 60–80 bpm) to prevent dissection expansion. (3) Pulmonary embolism and thrombus management: Sodium low molecular weight heparin 4250 IU subcutaneously every 12 hours, with dynamic monitoring of D-dimer and coagulation function. During treatment, D-dimer decreased from 8.45 μg/L at admission to 2.93 μg/L, and C-reactive protein decreased from 246.96 mg/L to 133.62 mg/L. At 2.5 months postoperatively, wounds on the right upper limb and both lower limbs were largely closed, with good survival of chest and back skin grafts. The patient's condition was stable. Conclusion: Large-area burns complicated by Stanford Type B aortic dissection and pulmonary embolism present a critically ill condition with prominent treatment dilemmas. Under the premise of confirming the dissection as chronic with a relatively stable false lumen, cautious anticoagulation with low molecular weight heparin combined with dynamic monitoring and staged surgical strategies can control thrombus risk while avoiding aortic dissection rupture. This case provides preliminary experience for managing such complex cases, though further clinical research is needed for validation.

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