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Emergency thoracic aortic stent grafting for acute complicated type B aortic dissection after a previous abdominal endovascular aneurysm repair

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ABSTRACT

We report a case of acute type B aortic dissection with the complication of bowel ischemia and abdominal stent graft compression treated by emergency thoracic aortic stent grafting after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). A 69-year-old male was admitted to our hospital for sudden thoraco-abdominal pain. He had past treatment history of EVAR for AAA half a year ago. A computed tomography (CT) showed acute type B aortic dissection, and conservative treatment was initially performed. Three days after occurrence of aortic dissection, worsened abdominal pain and melena were observed. CT showed that the true lumen and abdominal stent graft was compressed by the false lumen. Emergency thoracic endovascular repair (TEVAR) was performed to close the entry tear. After the operation, the image views and the symptoms were improved. The state was still stable 6 months later. TEVAR for acute type B aortic dissection can become one of the effective treatments.

No MeSH data available.


Related in: MedlinePlus

Preoperative CT images of aorta. The true lumen and the abdominal stent graft are compressed by the false lumen. “F” indicates false lumen. a CT image of thoracic aorta. b CT image of abdominal aorta. c CT image at the level of the celiac artery. d CT image at the level of the deformed previously abdominal stent graft (ENDURANT). Superior mesenteric artery (SMA) is shown with poor contrast effects suggesting SMA occlusion
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Fig1: Preoperative CT images of aorta. The true lumen and the abdominal stent graft are compressed by the false lumen. “F” indicates false lumen. a CT image of thoracic aorta. b CT image of abdominal aorta. c CT image at the level of the celiac artery. d CT image at the level of the deformed previously abdominal stent graft (ENDURANT). Superior mesenteric artery (SMA) is shown with poor contrast effects suggesting SMA occlusion

Mentions: A 69-year-old male with hypertension and diabetes mellitus complained of sudden thoraco-abdominal pain. He had a treatment history of endovascular aneurysm repair (EVAR) with ENDURANT II bifurcated AAA stent graft systems (Medtronic, Inc., Minneapolis, MN, USA) for an abdominal aortic aneurysm 6 months previously. A computed tomography (CT) scan showed acute type IIIb aortic dissection, which occurred from distal of the left subclavian artery to the renal artery. Conservative treatment was initially performed in another hospital. Three days after the occurrence of aortic dissection, worsened abdominal pain and melena were observed. CT showed that the true lumen was compressed by the false lumen (Fig. 1), especially at the level of the celiac artery (CA) (Fig. 1c). The abdominal stent graft was compressed by the false lumen, and superior mesenteric artery (SMA) was obstructed (Fig. 1d). He was transferred to our hospital immediately. On this admission, the abdominal pain was improved and the pulse of the bilateral femoral arteries was normal. However, ischemia of the left lower leg gradually occurred. Therefore, emergency thoracic endovascular repair (TEVAR) was performed to close the entry tear.Fig. 1


Emergency thoracic aortic stent grafting for acute complicated type B aortic dissection after a previous abdominal endovascular aneurysm repair
Preoperative CT images of aorta. The true lumen and the abdominal stent graft are compressed by the false lumen. “F” indicates false lumen. a CT image of thoracic aorta. b CT image of abdominal aorta. c CT image at the level of the celiac artery. d CT image at the level of the deformed previously abdominal stent graft (ENDURANT). Superior mesenteric artery (SMA) is shown with poor contrast effects suggesting SMA occlusion
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC4596147&req=5

Fig1: Preoperative CT images of aorta. The true lumen and the abdominal stent graft are compressed by the false lumen. “F” indicates false lumen. a CT image of thoracic aorta. b CT image of abdominal aorta. c CT image at the level of the celiac artery. d CT image at the level of the deformed previously abdominal stent graft (ENDURANT). Superior mesenteric artery (SMA) is shown with poor contrast effects suggesting SMA occlusion
Mentions: A 69-year-old male with hypertension and diabetes mellitus complained of sudden thoraco-abdominal pain. He had a treatment history of endovascular aneurysm repair (EVAR) with ENDURANT II bifurcated AAA stent graft systems (Medtronic, Inc., Minneapolis, MN, USA) for an abdominal aortic aneurysm 6 months previously. A computed tomography (CT) scan showed acute type IIIb aortic dissection, which occurred from distal of the left subclavian artery to the renal artery. Conservative treatment was initially performed in another hospital. Three days after the occurrence of aortic dissection, worsened abdominal pain and melena were observed. CT showed that the true lumen was compressed by the false lumen (Fig. 1), especially at the level of the celiac artery (CA) (Fig. 1c). The abdominal stent graft was compressed by the false lumen, and superior mesenteric artery (SMA) was obstructed (Fig. 1d). He was transferred to our hospital immediately. On this admission, the abdominal pain was improved and the pulse of the bilateral femoral arteries was normal. However, ischemia of the left lower leg gradually occurred. Therefore, emergency thoracic endovascular repair (TEVAR) was performed to close the entry tear.Fig. 1

View Article: PubMed Central

ABSTRACT

We report a case of acute type B aortic dissection with the complication of bowel ischemia and abdominal stent graft compression treated by emergency thoracic aortic stent grafting after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). A 69-year-old male was admitted to our hospital for sudden thoraco-abdominal pain. He had past treatment history of EVAR for AAA half a year ago. A computed tomography (CT) showed acute type B aortic dissection, and conservative treatment was initially performed. Three days after occurrence of aortic dissection, worsened abdominal pain and melena were observed. CT showed that the true lumen and abdominal stent graft was compressed by the false lumen. Emergency thoracic endovascular repair (TEVAR) was performed to close the entry tear. After the operation, the image views and the symptoms were improved. The state was still stable 6 months later. TEVAR for acute type B aortic dissection can become one of the effective treatments.

No MeSH data available.


Related in: MedlinePlus