A misplaced guide wire in the false lumen during endovascular repair of a type B aortic dissection

Objectives Chronic disseminated intravascular coagulation is a rare complication of aortic dissection, and its optimal treatment remains controversial. Methods We present a 78-year-old man with repeated hemorrhagic events by disseminated intravascular coagulation due to chronic aortic dissection treated by thoracic endovascular aortic repair. Results Computed tomography angiography at three months revealed a completely thrombosed false lumen from the distal aortic arch to the descending aorta at the celiac artery level. Platelets and D-dimer levels remained stable, and the patient was doing well without hemorrhagic complications. Conclusions Endovascular repair was effective for disseminated intravascular coagulation due to chronic type B aortic dissection.

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Endovascular Repair of Acute Type B Aortic Dissection: Long-Term Follow-Up of True and False Lumen Diameter Changes

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2006.10.064 ◽

2007 ◽

Vol 83 (3) ◽

pp. 1059-1066 ◽

Cited By ~ 117

Author(s):

Maria Schoder ◽

Martin Czerny ◽

Manfred Cejna ◽

Thomas Rand ◽

Alfred Stadler ◽

...

Keyword(s):

Aortic Dissection ◽

Endovascular Repair ◽

False Lumen ◽

Lumen Diameter ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection ◽

Long Term Follow Up

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How to Guide Stent-Graft Implantation in Type B Aortic Dissection?

Circulation ◽

10.1161/circulationaha.104.525972 ◽

2005 ◽

Vol 112 (9_supplement) ◽

Author(s):

Dietmar H. Koschyk ◽

Christoph A. Nienaber ◽

Malgorzata Knap ◽

Thomas Hofmann ◽

Yskert V. Kodolitsch ◽

...

Keyword(s):

Aortic Dissection ◽

Stent Graft ◽

Guide Wire ◽

False Lumen ◽

Entire Length ◽

Type B ◽

Type B Aortic Dissection ◽

Complex Anatomy ◽

Stent Graft Implantation ◽

Graft Implantation

Background— Despite growing interest in stent-graft implantation for type-B aortic dissection, there are no established recommendations to prepare and perform an implantation procedure. Methods and Results— We directly compared angiography (ANGIO), transesophageal echocardiography (TEE), and intravascular ultrasound (IVUS) intraprocedually before and after placement of 48 stent grafts in 42 consecutive patients (12 women, 61±11 years of age) with acute and chronic type-B aortic dissection for both usefulness and capability to guide aortic stent-graft implantation. Both IVUS and TEE are superior to ANGIO to identify multiple entries (52 and 43 versus 34; P <0.005 each), to diagnose false-lumen slow flow after stent-graft implantation (32 and 31 versus 24; P <0.005 each) and to detect incomplete stent apposition (18 and 16 versus 8; P <0.005 each). In comparison with ANGIO, guide wire position over the entire length of the aorta was documented more frequently by TEE and IVUS (40 and 42 versus 25; P <0.001 each). In 4 patients with abdominal extension of the dissection, only IVUS was able to accurately identify the false lumen over the entire length of the diseased aorta. TEE was superior to IVUS and ANGIO in the detection of endoleaks (5 versus 0 and 1; P <0.05 each). Intraprocedural ANGIO, TEE, and IVUS had been performed without complications in all patients. Conclusions— TEE in conjunction with ANGIO appears to be advantageous and adds incremental information to safely guide stent-graft placement in type-B aortic dissection. Additional use of IVUS was found to be helpful in patients with complex anatomy and abdominal extension of the dissection.

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Management of Acute Uncomplicated Stanford B Aortic Dissection in The Era of Endovascular Repair: A Case Report

Heart Science Journal ◽

10.21776/ub.hsj.2020.001.03.8 ◽

2020 ◽

Vol 1 (3) ◽

pp. 36-40

Author(s):

Putri Annisa Kamila ◽

Novi Kurnianingsih ◽

Sasmojo Widito ◽

Djanggan Sargowo ◽

Budi Satrijo

Keyword(s):

Aortic Dissection ◽

Femoral Artery ◽

Endovascular Repair ◽

False Lumen ◽

Long Term Results ◽

Type B ◽

Type B Aortic Dissection ◽

Medication Therapy ◽

Type B Dissection ◽

Stanford B

Introduction: Uncomplicated type B aortic dissections have been traditionally treated with medication therapy. While it may provide good short-term results, longterm prognosis may be less favorable. With improvements in endovascular repair and the potential risk of disease progression, thoracic endovascular aortic repair (TEVAR) has been considered inpatients with uncomplicated type B aortic dissection. We present the case of 78-year-old gentleman who presented with acute uncomplicated type B aortic dissection managed by endovascular repair Case illustration: A 78 year-old hypertensive patient admitted to the hospital with persistent chest discomfort and cough for 2 weeks. The CT aortic angiogram showed type B dissection. Based on the recent guidelines, TEVAR should be considered in patients with uncomplicated type B aortic dissection, thus we prepared the patient for TEVAR procedure. First we established multidisciplinary vascular team for the pre-procedural preparation of the patient. We perform careful measurement through detailed CT angiography reconstruction from carotid to femoral arteries. We found proximal diameter was 30-35mm, distal diameter was 23mm and landing zone right after left brachial ostium, suitable for stent graft Valiant Captivia 36-32x150mm. The CT also showed that both femoral artery were normal, we decided to use right femoral artery as the access. We proceed to the procedure 2 days later, under general anaesthesia, digital subtraction angiography revealed dissection of descending aorta, and selected device was inserted. Subsequent contrast injection revealed total occlusion of the false lumen. Patient was transferred to ICU for postprocedural care, and extubated the day after. The hospital stay was uneventful, and one-month follow up CT shows no endoleak. Conclusion : Management of uncomplicated Stanford B dissections is very challenging. TEVAR has emerged as an alternative to surgery with lower morbidity and mortality rates that might offer good long-term results.

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Hemodynamic parameters that may predict false-lumen growth in type-B aortic dissection after endovascular repair: A preliminary study on long-term multiple follow-ups

Medical Engineering & Physics ◽

10.1016/j.medengphy.2017.08.011 ◽

2017 ◽

Vol 50 ◽

pp. 12-21 ◽

Cited By ~ 6

Author(s):

Huanming Xu ◽

Zhenfeng Li ◽

Huiwu Dong ◽

Yilun Zhang ◽

Jianyong Wei ◽

...

Keyword(s):

Aortic Dissection ◽

Endovascular Repair ◽

False Lumen ◽

Hemodynamic Parameters ◽

Type B ◽

Type B Aortic Dissection ◽

Preliminary Study

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A computational model for false lumen thrombosis in type B aortic dissection following thoracic endovascular repair

Journal of Biomechanics ◽

10.1016/j.jbiomech.2017.10.029 ◽

2018 ◽

Vol 66 ◽

pp. 36-43 ◽

Cited By ~ 16

Author(s):

Claudia Menichini ◽

Zhuo Cheng ◽

Richard G.J. Gibbs ◽

Xiao Yun Xu

Keyword(s):

Aortic Dissection ◽

Computational Model ◽

Endovascular Repair ◽

False Lumen ◽

Type B ◽

Type B Aortic Dissection ◽

Thoracic Endovascular Repair

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Candy-plug technique for ruptured chronic type B aortic dissection

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492319853734 ◽

2019 ◽

Vol 27 (9) ◽

pp. 770-772

Author(s):

Akimasa Morisaki ◽

Etsuji Sohgawa ◽

Noriaki Kishimoto ◽

Kokoro Yamane ◽

Toshihiko Shibata

Keyword(s):

Computed Tomography ◽

Aortic Dissection ◽

Endovascular Repair ◽

Computed Tomography Angiography ◽

False Lumen ◽

Type B ◽

Type B Aortic Dissection ◽

Chronic Type ◽

Descending Aorta ◽

Mediastinal Hematoma

Ruptured chronic type B aortic dissection is conventionally repaired surgically; however, the mortality is high. We report successful use of the candy-plug technique for ruptured chronic type B aortic dissection. A 62-year-old man with ruptured type IIIb dissection was transferred to our hospital as an emergency. Computed tomography angiography showed a dissecting aorta with a patent false lumen, ruptured proximal descending aorta, distal aortic arch entry, and mediastinal hematoma. Debranching endovascular repair with the candy-plug technique achieved occlusion of the false lumen of the ruptured aortic dissection. The patient recovered uneventfully and the false lumen gradually decreased with no endoleak.

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