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Thoracic endovascular aortic repair for complicated chronic type B aortic dissection in a patient on hemodialysis with recurrent ischemic colitis.

Miyazaki Y, Furuyama T, Matsubara Y, Yoshiya K, Yoshiga R, Inoue K, Matsuda D, Aoyagi Y, Kato M, Matsumoto T, Maehara Y - Surg Case Rep (2016)

Bottom Line: The celiac artery and superior mesenteric artery (SMA) arose from the true lumen, and these were compressed by the expanded false lumen.Seven days after this operation, enhanced computed tomography showed that the patient's true lumen was expanded and her blood flow to the true lumen and SMA was improved.We believe that TEVAR supplemented by a noncovered aortic stent is an effective treatment, even for highly chronic B-AD in dialysis patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Fukuoka, Japan.

ABSTRACT
We present a successful case of thoracic endovascular aortic repair (TEVAR) for chronic Stanford type B aortic dissection (B-AD) with recurrent ischemic colitis. The patient was a 56-year-old woman with abdominal pain as the main complaint who had two operations previously: the total arch replacement 8 years ago and the Bentall 7 years ago for acute Stanford type A aortic dissection. Her abdominal pain worsened as her blood pressure became low during her hemodialysis treatment. An enhanced computed tomography scan was performed on the patient and showed chronic B-AD that occurred from the distal anastomotic part of the total arch graft to the bilateral common iliac arteries. The celiac artery and superior mesenteric artery (SMA) arose from the true lumen, and these were compressed by the expanded false lumen. Her complicated chronic B-AD was treated with the Zenith Dissection Endovascular System, and its procedure was performed as her proximal entry tear was covered by a proximal tapered Zenith TX2 stent graft, supplemented by a noncovered aortic stent extending across both renal arteries, the SMA, and the celiac artery. Seven days after this operation, enhanced computed tomography showed that the patient's true lumen was expanded and her blood flow to the true lumen and SMA was improved. On the other hand, her false lumen tended to be thrombosed. Consequently, she was discharged 10 days after the operation without any postoperative complications as she had no abdominal complaints even though she underwent hemodialysis three times per week after the operation. We believe that TEVAR supplemented by a noncovered aortic stent is an effective treatment, even for highly chronic B-AD in dialysis patients.

No MeSH data available.


Related in: MedlinePlus

a A white coating could be seen in the vicinity of the Bauhin valve. b Localized distorted ulcers could be seen in the ascending colon. Mucosal necrosis was not found
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Fig1: a A white coating could be seen in the vicinity of the Bauhin valve. b Localized distorted ulcers could be seen in the ascending colon. Mucosal necrosis was not found

Mentions: Her initial abdominal pain with ischemic colitis occurred 1 year ago, and colonoscopy was performed. By the diagnosis of the colonoscopy, we found a white coating in the vicinity of the Bauhin valve and localized distorted ulcers in the ascending colon. However, mucosal necrosis was not found (Fig. 1). Since her symptoms were slight and temporary, she remained on conservative treatments at that time. Her abdominal pain became worse; melena occurred often during the course of her conservative treatments, and these symptoms occurred when blood pressure became low under hemodialysis. Then, she was referred to our hospital for further evaluation of her recurrent ischemic colitis. Computed tomography (CT) scans showed chronic B-AD, which extended from the distal anastomotic part of the total arch graft to both common iliac arteries. The distal re-entry size was 26 mm. The expanded false lumen compressed the true lumen of most of the aorta, including the origin of the superior mesenteric artery (SMA) (Fig. 2).Fig. 1


Thoracic endovascular aortic repair for complicated chronic type B aortic dissection in a patient on hemodialysis with recurrent ischemic colitis.

Miyazaki Y, Furuyama T, Matsubara Y, Yoshiya K, Yoshiga R, Inoue K, Matsuda D, Aoyagi Y, Kato M, Matsumoto T, Maehara Y - Surg Case Rep (2016)

a A white coating could be seen in the vicinity of the Bauhin valve. b Localized distorted ulcers could be seen in the ascending colon. Mucosal necrosis was not found
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4835411&req=5

Fig1: a A white coating could be seen in the vicinity of the Bauhin valve. b Localized distorted ulcers could be seen in the ascending colon. Mucosal necrosis was not found
Mentions: Her initial abdominal pain with ischemic colitis occurred 1 year ago, and colonoscopy was performed. By the diagnosis of the colonoscopy, we found a white coating in the vicinity of the Bauhin valve and localized distorted ulcers in the ascending colon. However, mucosal necrosis was not found (Fig. 1). Since her symptoms were slight and temporary, she remained on conservative treatments at that time. Her abdominal pain became worse; melena occurred often during the course of her conservative treatments, and these symptoms occurred when blood pressure became low under hemodialysis. Then, she was referred to our hospital for further evaluation of her recurrent ischemic colitis. Computed tomography (CT) scans showed chronic B-AD, which extended from the distal anastomotic part of the total arch graft to both common iliac arteries. The distal re-entry size was 26 mm. The expanded false lumen compressed the true lumen of most of the aorta, including the origin of the superior mesenteric artery (SMA) (Fig. 2).Fig. 1

Bottom Line: The celiac artery and superior mesenteric artery (SMA) arose from the true lumen, and these were compressed by the expanded false lumen.Seven days after this operation, enhanced computed tomography showed that the patient's true lumen was expanded and her blood flow to the true lumen and SMA was improved.We believe that TEVAR supplemented by a noncovered aortic stent is an effective treatment, even for highly chronic B-AD in dialysis patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Fukuoka, Japan.

ABSTRACT
We present a successful case of thoracic endovascular aortic repair (TEVAR) for chronic Stanford type B aortic dissection (B-AD) with recurrent ischemic colitis. The patient was a 56-year-old woman with abdominal pain as the main complaint who had two operations previously: the total arch replacement 8 years ago and the Bentall 7 years ago for acute Stanford type A aortic dissection. Her abdominal pain worsened as her blood pressure became low during her hemodialysis treatment. An enhanced computed tomography scan was performed on the patient and showed chronic B-AD that occurred from the distal anastomotic part of the total arch graft to the bilateral common iliac arteries. The celiac artery and superior mesenteric artery (SMA) arose from the true lumen, and these were compressed by the expanded false lumen. Her complicated chronic B-AD was treated with the Zenith Dissection Endovascular System, and its procedure was performed as her proximal entry tear was covered by a proximal tapered Zenith TX2 stent graft, supplemented by a noncovered aortic stent extending across both renal arteries, the SMA, and the celiac artery. Seven days after this operation, enhanced computed tomography showed that the patient's true lumen was expanded and her blood flow to the true lumen and SMA was improved. On the other hand, her false lumen tended to be thrombosed. Consequently, she was discharged 10 days after the operation without any postoperative complications as she had no abdominal complaints even though she underwent hemodialysis three times per week after the operation. We believe that TEVAR supplemented by a noncovered aortic stent is an effective treatment, even for highly chronic B-AD in dialysis patients.

No MeSH data available.


Related in: MedlinePlus