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Emergency endovascular repair of acute descending thoracic aortic dissection.

Sharif MA, O'Donnell ME, Blair PH, Kennedy P - Vasc Health Risk Manag (2007)

Bottom Line: The patient presented with epigastric pain radiating to the interscapular region with a stable hemodynamic status.A successful endovascular repair was carried out with uneventful recovery and follow-up CT scan six years after stent-grafting shows satisfactory position of the stent-graft, patent false lumen in the abdominal aorta perfusing the right kidney, and progressively enlarging diameter of the abdominal aorta.Regular follow-up with CT scan is required to evaluate the long-term efficacy and identify the need for re-intervention.

View Article: PubMed Central - PubMed

Affiliation: Department of Vascular and Endovascular Surgery, Royal Victoria Hospital, Belfast, United Kingdom. aneessharif@yahoo.co.uk

ABSTRACT

Background: Acute descending thoracic aortic dissection is a life-threatening emergency. It is not often considered as the initial diagnosis in patients presenting with epigastric pain and could easily be missed in a busy casualty department.

Aim: This case report is aimed to highlight the feasibility of the technique and the need for long-term surveillance following endovascular repair of acute thoracic aortic dissection.

Results: The patient presented with epigastric pain radiating to the interscapular region with a stable hemodynamic status. A computerized tomography (CT) scan demonstrated type B thoracic aortic dissection of the proximal descending thoracic aorta. A successful endovascular repair was carried out with uneventful recovery and follow-up CT scan six years after stent-grafting shows satisfactory position of the stent-graft, patent false lumen in the abdominal aorta perfusing the right kidney, and progressively enlarging diameter of the abdominal aorta.

Conclusion: Thoracic aortic dissection should be considered as a differential diagnosis in patients presenting with epigastric and interscapular chest pain. Emergency endovascular repair of acute thoracic aortic dissection is feasible and relatively safe. Regular follow-up with CT scan is required to evaluate the long-term efficacy and identify the need for re-intervention.

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Related in: MedlinePlus

Arch angiogram showing the proximal entry tear into the false lumen (arrow).
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fig2: Arch angiogram showing the proximal entry tear into the false lumen (arrow).

Mentions: An arch angiogram showed the proximal entry tear into the false lumen (Figure 2). The right femoral artery was explored and a single thoracic stent-graft measuring 37 mm by 15 cm (Gore TagĀ®, WL Gore and Associates, Inc., Flagstaff, Arizona, USA) was successfully deployed in the descending thoracic aorta to seal off the entry tear, without covering the ostium of the left subclavian artery (Figure 3). The stent-graft was oversized by 15% for the thoracic aortic diameter. Repeat angiogram showed that the entry tear was closed and the right renal artery remained patent and perfused by the false lumen with flow entering into the re-entry site within the right EIA. Two further stents were placed in the right EIA to seal off the exit site of dissection. However, the dissection flap was torn proximally into the distal abdominal aorta with persistent flow into the false lumen perfusing the right kidney. A decision was made to leave and monitor the re-entry tear with serial CT scans. The right femoral artery was closed and a drain was placed in the groin wound for three days.


Emergency endovascular repair of acute descending thoracic aortic dissection.

Sharif MA, O'Donnell ME, Blair PH, Kennedy P - Vasc Health Risk Manag (2007)

Arch angiogram showing the proximal entry tear into the false lumen (arrow).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2291323&req=5

fig2: Arch angiogram showing the proximal entry tear into the false lumen (arrow).
Mentions: An arch angiogram showed the proximal entry tear into the false lumen (Figure 2). The right femoral artery was explored and a single thoracic stent-graft measuring 37 mm by 15 cm (Gore TagĀ®, WL Gore and Associates, Inc., Flagstaff, Arizona, USA) was successfully deployed in the descending thoracic aorta to seal off the entry tear, without covering the ostium of the left subclavian artery (Figure 3). The stent-graft was oversized by 15% for the thoracic aortic diameter. Repeat angiogram showed that the entry tear was closed and the right renal artery remained patent and perfused by the false lumen with flow entering into the re-entry site within the right EIA. Two further stents were placed in the right EIA to seal off the exit site of dissection. However, the dissection flap was torn proximally into the distal abdominal aorta with persistent flow into the false lumen perfusing the right kidney. A decision was made to leave and monitor the re-entry tear with serial CT scans. The right femoral artery was closed and a drain was placed in the groin wound for three days.

Bottom Line: The patient presented with epigastric pain radiating to the interscapular region with a stable hemodynamic status.A successful endovascular repair was carried out with uneventful recovery and follow-up CT scan six years after stent-grafting shows satisfactory position of the stent-graft, patent false lumen in the abdominal aorta perfusing the right kidney, and progressively enlarging diameter of the abdominal aorta.Regular follow-up with CT scan is required to evaluate the long-term efficacy and identify the need for re-intervention.

View Article: PubMed Central - PubMed

Affiliation: Department of Vascular and Endovascular Surgery, Royal Victoria Hospital, Belfast, United Kingdom. aneessharif@yahoo.co.uk

ABSTRACT

Background: Acute descending thoracic aortic dissection is a life-threatening emergency. It is not often considered as the initial diagnosis in patients presenting with epigastric pain and could easily be missed in a busy casualty department.

Aim: This case report is aimed to highlight the feasibility of the technique and the need for long-term surveillance following endovascular repair of acute thoracic aortic dissection.

Results: The patient presented with epigastric pain radiating to the interscapular region with a stable hemodynamic status. A computerized tomography (CT) scan demonstrated type B thoracic aortic dissection of the proximal descending thoracic aorta. A successful endovascular repair was carried out with uneventful recovery and follow-up CT scan six years after stent-grafting shows satisfactory position of the stent-graft, patent false lumen in the abdominal aorta perfusing the right kidney, and progressively enlarging diameter of the abdominal aorta.

Conclusion: Thoracic aortic dissection should be considered as a differential diagnosis in patients presenting with epigastric and interscapular chest pain. Emergency endovascular repair of acute thoracic aortic dissection is feasible and relatively safe. Regular follow-up with CT scan is required to evaluate the long-term efficacy and identify the need for re-intervention.

Show MeSH
Related in: MedlinePlus