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Successful Endovascular Stent-Graft Repair for Complicated Type B Aortic Dissection Developed in a Patient with Polycystic Kidney Disease.

Jung CS, Park BW, Bang DW, Jang WH, Kim HS, Oh JH - Vasc Specialist Int (2015)

Bottom Line: Although endovascular stent-graft repair tends to show better outcomes than conventional therapies in complicated type B AD (TBAD), successful endovascular intervention of TBAD with malperfusion in a patient with PCKD has not been reported.Four days after discharge, he was rehospitalized with left leg pain and paresthesia due to left lower leg malperfusion.Thoracic endovascular stent-graft repair covering the primary tear site of dissection was performed successfully, leading to a decrease in false lumen and improvement of symptoms.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea.

ABSTRACT
Polycystic kidney disease (PCKD) is rarely associated with aortic dissection (AD), which is a life-threatening disease. Although endovascular stent-graft repair tends to show better outcomes than conventional therapies in complicated type B AD (TBAD), successful endovascular intervention of TBAD with malperfusion in a patient with PCKD has not been reported. This case shows a 37-year-old male who had sudden onset of sharply stabbing epigastric pain with severe hypertension, who was diagnosed with TBAD and PCKD by a computed tomography and initially underwent medical treatment. Four days after discharge, he was rehospitalized with left leg pain and paresthesia due to left lower leg malperfusion. Thoracic endovascular stent-graft repair covering the primary tear site of dissection was performed successfully, leading to a decrease in false lumen and improvement of symptoms. We report the case of complicated TBAD in a patient with PCKD treated with endovascular stent-graft repair.

No MeSH data available.


Related in: MedlinePlus

Computed tomography of the chest and abdomen. (A) Dissection of the aortic arch distal to the left subclavian artery, sagittal view and (B) transverse view. (C) Left common iliac artery is almost obstructed by the false lumen with thrombus (arrow). (D) Multiple variable-sized cystic lesions in the liver and both kidneys.
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f1-vsi-31-58: Computed tomography of the chest and abdomen. (A) Dissection of the aortic arch distal to the left subclavian artery, sagittal view and (B) transverse view. (C) Left common iliac artery is almost obstructed by the false lumen with thrombus (arrow). (D) Multiple variable-sized cystic lesions in the liver and both kidneys.

Mentions: A 37-year-old male presented to the emergency room with sudden onset of sharply stabbing epigastric pain never felt before. He had a history of hypertension with no medication. His vital signs were as follows: blood pressure, 220/150 mmHg; pulse rate, 87 beats/minute; respiratory rate, 18 breaths/minute; and body temperature, 36.6°C. Physical examination revealed a weak pulsation on the left femoral artery and mild tenderness in the epigastric area. An electrocardiogram showed left ventricular hypertrophy with normal sinus rhythm. Chest radiography showed small amounts of bilateral pleural effusion without cardiomegaly. All blood chemistry profiles were within normal limits except mild renal dysfunction; they were as follows: creatinine 1.28 mg/dL (estimated glomerular filtration rate: 71.0 mL/min), blood urea nitrogen 19 mg/dL, random glucose 152 mg/dL, total cholesterol 160 mg/dL, and uric acid 7.9 mg/dL. In a computed tomography (CT) of the chest and abdomen with contrast, TBAD originating from the aortic arch just next to the left subclavian artery and terminating at both common and external iliac arteries was observed (Fig. 1A, B). The left common iliac artery and celiac trunk were almost obstructed by thrombus in the false lumen (Fig. 1C). Multiple variable-sized cysts in the liver and both kidneys were found, compatible with PCKD (Fig. 1D). The family history for autosomal dominant PCKD was not evident, because he had no siblings and his parents died when he was young. Echocardiogram showed left ventricular hypertrophy (septal wall thickness on diastole, 14.3 mm) and minimal amount of pericardial effusion with a left ventricular ejection fraction of 56%. The ankle-brachial index (ABI) was 0.41 at 2 days after admission and improved to 0.74 before discharge. Follow-up CT scan showed a similarly severe but shorter occlusion of the left common iliac artery compared with the previous CT scan (Fig. 2A, B). He had medical treatment with carvedilol 25 mg, nifedipine 66 mg, diltiazem 90 mg for twice-daily dosing and candesartan 16mg, minoxidil 5 mg for once-daily dosing. He was discharged 11 days after admission under stable conditions including a mild claudication.


Successful Endovascular Stent-Graft Repair for Complicated Type B Aortic Dissection Developed in a Patient with Polycystic Kidney Disease.

Jung CS, Park BW, Bang DW, Jang WH, Kim HS, Oh JH - Vasc Specialist Int (2015)

Computed tomography of the chest and abdomen. (A) Dissection of the aortic arch distal to the left subclavian artery, sagittal view and (B) transverse view. (C) Left common iliac artery is almost obstructed by the false lumen with thrombus (arrow). (D) Multiple variable-sized cystic lesions in the liver and both kidneys.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508655&req=5

f1-vsi-31-58: Computed tomography of the chest and abdomen. (A) Dissection of the aortic arch distal to the left subclavian artery, sagittal view and (B) transverse view. (C) Left common iliac artery is almost obstructed by the false lumen with thrombus (arrow). (D) Multiple variable-sized cystic lesions in the liver and both kidneys.
Mentions: A 37-year-old male presented to the emergency room with sudden onset of sharply stabbing epigastric pain never felt before. He had a history of hypertension with no medication. His vital signs were as follows: blood pressure, 220/150 mmHg; pulse rate, 87 beats/minute; respiratory rate, 18 breaths/minute; and body temperature, 36.6°C. Physical examination revealed a weak pulsation on the left femoral artery and mild tenderness in the epigastric area. An electrocardiogram showed left ventricular hypertrophy with normal sinus rhythm. Chest radiography showed small amounts of bilateral pleural effusion without cardiomegaly. All blood chemistry profiles were within normal limits except mild renal dysfunction; they were as follows: creatinine 1.28 mg/dL (estimated glomerular filtration rate: 71.0 mL/min), blood urea nitrogen 19 mg/dL, random glucose 152 mg/dL, total cholesterol 160 mg/dL, and uric acid 7.9 mg/dL. In a computed tomography (CT) of the chest and abdomen with contrast, TBAD originating from the aortic arch just next to the left subclavian artery and terminating at both common and external iliac arteries was observed (Fig. 1A, B). The left common iliac artery and celiac trunk were almost obstructed by thrombus in the false lumen (Fig. 1C). Multiple variable-sized cysts in the liver and both kidneys were found, compatible with PCKD (Fig. 1D). The family history for autosomal dominant PCKD was not evident, because he had no siblings and his parents died when he was young. Echocardiogram showed left ventricular hypertrophy (septal wall thickness on diastole, 14.3 mm) and minimal amount of pericardial effusion with a left ventricular ejection fraction of 56%. The ankle-brachial index (ABI) was 0.41 at 2 days after admission and improved to 0.74 before discharge. Follow-up CT scan showed a similarly severe but shorter occlusion of the left common iliac artery compared with the previous CT scan (Fig. 2A, B). He had medical treatment with carvedilol 25 mg, nifedipine 66 mg, diltiazem 90 mg for twice-daily dosing and candesartan 16mg, minoxidil 5 mg for once-daily dosing. He was discharged 11 days after admission under stable conditions including a mild claudication.

Bottom Line: Although endovascular stent-graft repair tends to show better outcomes than conventional therapies in complicated type B AD (TBAD), successful endovascular intervention of TBAD with malperfusion in a patient with PCKD has not been reported.Four days after discharge, he was rehospitalized with left leg pain and paresthesia due to left lower leg malperfusion.Thoracic endovascular stent-graft repair covering the primary tear site of dissection was performed successfully, leading to a decrease in false lumen and improvement of symptoms.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea.

ABSTRACT
Polycystic kidney disease (PCKD) is rarely associated with aortic dissection (AD), which is a life-threatening disease. Although endovascular stent-graft repair tends to show better outcomes than conventional therapies in complicated type B AD (TBAD), successful endovascular intervention of TBAD with malperfusion in a patient with PCKD has not been reported. This case shows a 37-year-old male who had sudden onset of sharply stabbing epigastric pain with severe hypertension, who was diagnosed with TBAD and PCKD by a computed tomography and initially underwent medical treatment. Four days after discharge, he was rehospitalized with left leg pain and paresthesia due to left lower leg malperfusion. Thoracic endovascular stent-graft repair covering the primary tear site of dissection was performed successfully, leading to a decrease in false lumen and improvement of symptoms. We report the case of complicated TBAD in a patient with PCKD treated with endovascular stent-graft repair.

No MeSH data available.


Related in: MedlinePlus