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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

Post-procedure computed tomography of the chest and abdomen. (A) Thoracic endovascular stent-graft repair. (B) Improvement of the left common iliac artery obstruction and false lumen thrombosis (arrow).
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f3-vsi-31-58: Post-procedure computed tomography of the chest and abdomen. (A) Thoracic endovascular stent-graft repair. (B) Improvement of the left common iliac artery obstruction and false lumen thrombosis (arrow).

Mentions: Four days after discharge, he was hospitalized again for severe left leg pain and paresthesia while walking. Blood pressure was normal during hospitalization, but the left femoral artery pulse was not palpable. Emergent arteriography revealed complete obstruction of the left common iliac artery. There was normal perfusion of the celiac, superior mesenteric and renal arteries via the true lumen. After being diagnosed as left lower leg malperfusion (LLM), thoracic endovascular stent-graft repair (TEVAR) was performed immediately via femoral cut-down approach under general anesthesia. The proximal edge of the dissected aorta had a diameter of 33 mm. The selected graft was 34×150 mm sized Valiant Thoracic Stent Graft (Medtronic Vascular, Santa Rosa, CA, USA). Post-CT scan of the aorta with contrast after the procedure showed improvement of flow of the left common iliac artery (Fig. 3). Pain and paresthesia of the left leg was relieved dramatically after the procedure. Since then, he was free of any symptoms. Two years later, follow-up CT confirmed no signs of malperfusion (Fig. 2C).


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)

Post-procedure computed tomography of the chest and abdomen. (A) Thoracic endovascular stent-graft repair. (B) Improvement of the left common iliac artery obstruction and false lumen thrombosis (arrow).
© Copyright Policy
Related In: Results  -  Collection

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

f3-vsi-31-58: Post-procedure computed tomography of the chest and abdomen. (A) Thoracic endovascular stent-graft repair. (B) Improvement of the left common iliac artery obstruction and false lumen thrombosis (arrow).
Mentions: Four days after discharge, he was hospitalized again for severe left leg pain and paresthesia while walking. Blood pressure was normal during hospitalization, but the left femoral artery pulse was not palpable. Emergent arteriography revealed complete obstruction of the left common iliac artery. There was normal perfusion of the celiac, superior mesenteric and renal arteries via the true lumen. After being diagnosed as left lower leg malperfusion (LLM), thoracic endovascular stent-graft repair (TEVAR) was performed immediately via femoral cut-down approach under general anesthesia. The proximal edge of the dissected aorta had a diameter of 33 mm. The selected graft was 34×150 mm sized Valiant Thoracic Stent Graft (Medtronic Vascular, Santa Rosa, CA, USA). Post-CT scan of the aorta with contrast after the procedure showed improvement of flow of the left common iliac artery (Fig. 3). Pain and paresthesia of the left leg was relieved dramatically after the procedure. Since then, he was free of any symptoms. Two years later, follow-up CT confirmed no signs of malperfusion (Fig. 2C).

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