P-052 - ACUTE TYPE B AORTIC DISSECTION COMPLICATED BY PARAPLEGIA AND COLLAPSE OF ABDOMINAL AORTIC ENDOGRAFT

TOPIC:
Case Reports
AUTHORS:
Vona S. (Vascular Surgery Unit, Biomedicine and Prevention Department, "Tor Vergata" University ~ Rome ~ Italy) , Fazzini S. (Vascular Surgery Unit, Biomedicine and Prevention Department, "Tor Vergata" University ~ Rome ~ Italy) , Orellana Dávila B. (Vascular Surgery Unit, Biomedicine and Prevention Department, "Tor Vergata" University ~ Rome ~ Italy) , De Giorgi A. (Vascular Surgery Unit, Biomedicine and Prevention Department, "Tor Vergata" University ~ Rome ~ Italy) , Sciarra A. (Vascular Surgery Unit, Biomedicine and Prevention Department, "Tor Vergata" University ~ Rome ~ Italy) , Oddi F.M. (Vascular Surgery Unit, Biomedicine and Prevention Department, "Tor Vergata" University ~ Rome ~ Italy) , Ascoli Marchetti A. (Vascular Surgery Unit, Biomedicine and Prevention Department, "Tor Vergata" University ~ Rome ~ Italy) , Ippoliti A. (Vascular Surgery Unit, Biomedicine and Prevention Department, "Tor Vergata" University ~ Rome ~ Italy)
Introduction:
Acute type B aortic dissection can present or evolve quickly with complications that often include true lumen compression associated to organ failure and/or limb ischemia. We describe the case of a 72-year-old male patient who arrived at the emergency room because of intense interscapular chest pain. The patient had undergone previous endovascular abdominal aneurysm repair with a Gore Excluder endograft (W.L. Gore and Associates, Flagstaff, AZ, USA).
Methods:
An urgent computed tomography angiography (CTA) showed an acute type B aortic dissection without ruptures and/or visceral malperfusion. There were no high-risk anatomical signs. Therefore, the patient was referred to best medical therapy in order to achieve the better antihypertensive and analgesic therapy. Twenty-four hours later, the patient had a hypertensive peak along with chest pain, paraplegia and acute ischemia of the left lower limb. An urgent CTA showed the worsening of the aortic dissection with antegrade progression of the false lumen and consensual severe compression of the true lumen, which caused the collapse of the abdominal endograft. Urgent endovascular treatment was indicated, after placement of spinal drainage.
Results:
Under general anesthesia, through a single percutaneous right femoral access, the true lumen was cannulated from below and checked by intravascular ultrasound, in order to confirm the position inside the true lumen and to evaluate aortic diameters and abdominal endograft collapse. A thoracic endograft (Gore CTAG) was deployed distal to the left subclavian artery. Consequently, the coverage of the entry tear allowed immediate re-expansion of the true lumen, of the abdominal endograft and the left ileo-femoral axis, with presence of the left femoral pulse.
Conclusion:
The postoperative CTA confirmed the correct positioning of the thoracic endograft with expansion of the true lumen and abdominal endograft, without any aortic complication. During the following days the chest pain totally regressed and the neurological deficit progressively improved. The patient was discharged after one week, with partial self-sufficiency to walk and home-based exercise therapy, which allowed him a complete recovery; one month later he performed CTA which showed no complications and further improvement in aortic remodeling.
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