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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

Blood flow of the true lumen and SMA was improved. The false lumen remained but tended to be thrombosed. a Sagittal slice, b axial slice at the level of bronchial bifurcation, and c axial slice at the level of the SMA. T true lumen, F false lumen
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Fig4: Blood flow of the true lumen and SMA was improved. The false lumen remained but tended to be thrombosed. a Sagittal slice, b axial slice at the level of bronchial bifurcation, and c axial slice at the level of the SMA. T true lumen, F false lumen

Mentions: Seven days after the operation, CT showed improved blood flow in the true lumen, CA, and SMA, and the false lumen tended to be thrombosed (Fig. 4). She was discharged 10 days after the operation without any postoperative complications. She then underwent hemodialysis three times per week after the operation, but her abdominal pain following hypotension due to hemodialysis had completely disappeared. She remained well for 6 months after the operation.Fig. 4


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)

Blood flow of the true lumen and SMA was improved. The false lumen remained but tended to be thrombosed. a Sagittal slice, b axial slice at the level of bronchial bifurcation, and c axial slice at the level of the SMA. T true lumen, F false lumen
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig4: Blood flow of the true lumen and SMA was improved. The false lumen remained but tended to be thrombosed. a Sagittal slice, b axial slice at the level of bronchial bifurcation, and c axial slice at the level of the SMA. T true lumen, F false lumen
Mentions: Seven days after the operation, CT showed improved blood flow in the true lumen, CA, and SMA, and the false lumen tended to be thrombosed (Fig. 4). She was discharged 10 days after the operation without any postoperative complications. She then underwent hemodialysis three times per week after the operation, but her abdominal pain following hypotension due to hemodialysis had completely disappeared. She remained well for 6 months after the operation.Fig. 4

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