Abstract

ROLIM, Dalila et al. Thoracoabdominal aneurysm post type B chronic dissection: an anatomically challenging case with an unexpectedly simple endovascular solution. Angiol Cir Vasc [online]. 2016, vol.12, n.1, pp.50-54. ISSN 1646-706X.  https://doi.org/10.1016/j.ancv.2015.12.009.

Introduction: With medical management, 77,6% survived the chronic phase of aortic dissection. Twenty five to forty percent of patients surviving acute aortic dissection will progress to aneurysm dilatation. Case Report: Male patient, 73 year-old, with a history of hypertension. He was admitted with a perforated acute cholecystitis. Imaging workup documented a thoracoabdominal aneurysm post type B chronic dissection. Specifically, angio-CT revealed a heavily calcified entry flap in the transition from the middle to the bottom third of the descending thoracic aorta. Aneurismal degeneration of the distal thoracic aorta had occurred; contained rupture could not be excluded. The celiac trunk, superior mesenteric and renal arteries originated from the true lumen. A reentry tear was visible in the posterior aorta surface, between the two renal arteries. The dissected aortic segment was markedly calcified (both the true and false lumen outer walls as well as the dividing wall between them). True lumen was significantly stenosed. The patient remained under antibiotic therapy and aggressive blood pressure control. Ultrasound-guided percutaneous cholecystostomy was performed. He then underwent an elective expeditious conic tubular stentgraft implantation, immediately above the celiac trunk origin. Slow false lumen retrograde perfusion, from what had been the reentry tear, was still present at completion angiogram. An expectant attitude was undertaken. Four days after intervention the control CT documented a favorable outcome. False lumen thrombosis had been induced and excluding therefore the aneurysm.

Keywords : Type B aortic chronic dissection; Toraco-abdominal aortic aneurysm; Thoracic aortic endovascular treatment.

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