Repeated Peripheral Embolisms associated with Chronic Aortic Dissection

AbstractA male patient developed acute type B aortic dissection (AD) extending to the right external iliac artery (EIA) and left common femoral artery at the age of 56 years. Two months after the diagnosis of AD, he developed right renal infarction suggesting embolism, as the right renal artery arose from a false lumen containing a mural thrombus. Seven years later, at the age of 63 years, the patient was readmitted for acute onset of intermittent claudication in the right leg. On admission, arterial pulses distal to the right femoral artery were absent. The right ankle-brachial pressure index (ABI) was 0.66, while the left ABI was 1.06. Computed tomography (CT) confirmed chronic type B AD and revealed a localized occlusion of the right EIA and disappearance of a small protruding thrombus in the false lumen that was found on the previous CT, suggesting a second embolism. Since recovery of antegrade blood flow was insufficient after catheter embolectomy, femorofemoral bypass was performed with resolution of ischemic symptoms. Postoperatively, the ABI recovered to 0.99 in the right and 1.12 in the left, and CT showed a patent bypass graft and restoration of blood flow to the right leg. This case indicates that embolism should be recognized as one of the possible causes of acute organ ischemia in patients with AD, even in patients with chronic AD.

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Treatment of Acute Stanford Type B Aortic Dissection With a Novel Cylindrical Balloon Catheter in Dogs

Circulation ◽

10.1161/circ.102.suppl_3.iii-259 ◽

2000 ◽

Vol 102 (suppl_3) ◽

Author(s):

Hiromu Terai ◽

Nobushige Tamura ◽

Tatsuo Nakamura ◽

Kazunobu Nishimura ◽

Norimasa Tsutsui ◽

...

Keyword(s):

Blood Flow ◽

Aortic Dissection ◽

Balloon Catheter ◽

False Lumen ◽

Aortic Blood Flow ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection ◽

True Lumen ◽

Descending Aorta

Background —Despite recent progress in medical and surgical treatment, acute type B aortic dissection still carries a high mortality rate. We have developed a novel cylindrical balloon catheter for less invasive treatment to block the entry of the dissection and induce thrombotic occlusion of the false lumen. The balloon has the shape of a sheet when deflated but a double-cylinder shape when inflated. Therefore, aortic blood flow is maintained through the cylindrical lumen during balloon inflation. Methods and Results —Six beagle dogs underwent a left thoracotomy at the 6th intercostal space. An acute dissection of 4-cm length was created surgically on the descending aorta. The balloon catheter was inserted through the distal descending aorta and advanced to the entry site. The balloon catheter was inflated for 6 hours. The blood flow in the descending aorta and the position of the balloon was monitored by color Doppler echovasculography. Four dogs were killed humanely on the following day and 2 dogs 10 days after the surgery. The descending aorta was examined macroscopically and microscopically in all dogs. In all dogs, the false lumen was occluded by thrombi. Although no dog had clinical evidence of distal thromboembolism, 2 of the 4 dogs that were killed on the second postoperative day had fresh mural thrombi in the true lumen. Conclusions —The false lumen of the acute type B aortic dissection was effectively occluded by the novel cylindrical balloon catheter in the canine experimental model. The thrombus formation in the true lumen is the problem to be solved.

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Thoracic endovascular aortic repair for acute type B aortic dissection complicated by total occlusion of the abdominal aorta

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivaa020 ◽

2020 ◽

Vol 30 (6) ◽

pp. 940-942

Author(s):

Daichi Shikata ◽

Atsushi Omura ◽

Jiro Matsuo ◽

Hitoshi Matsuda

Keyword(s):

Aortic Dissection ◽

Abdominal Aorta ◽

Femoral Artery ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Acute Type ◽

Lower Body ◽

Type B ◽

Type B Aortic Dissection ◽

The Right

Abstract A 72-year-old man presenting with lower body malperfusion and complete paralysis was transferred for emergency treatment of a complicated acute type B aortic dissection. Enhanced computed tomography showed occlusion of the true lumen inside the abdominal aorta due to compression of the false lumen, accompanied by a Crawford extension type IV thoraco-abdominal aortic aneurysm. The primary entry tear was located at the level of the tenth thoracic vertebra above the aneurysm. Emergency thoracic endovascular aortic repair was performed to cover the entry tear and to regain perfusion of the lower body. Efforts to perform retrograde insertion of a guidewire from the femoral arteries to pass the occluded abdominal aorta were unsuccessful. A through-and-through guidewire technique between the left brachial artery and the right femoral artery was performed to deliver a Zenith TX-2 stent graft from the right femoral artery. After closure of the primary entry tear, complete recovery from the occlusion of the abdominal aorta was obtained 6 h after the onset. His paralysis recovered completely, and the postoperative course was uneventful without reperfusion injury.

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Spinal Cord Ischemia in the Setting of Acute Type B Aortic Dissection: Successful Rescue with Thoracic Endovascular Aortic Repair

Vascular and Endovascular Surgery ◽

10.1177/15385744211045156 ◽

2021 ◽

pp. 153857442110451

Author(s):

Masaki Kano ◽

Toru Iwahashi ◽

Toshiya Nishibe ◽

Kentaro Kamiya ◽

Hitoshi Ogino

Keyword(s):

Spinal Cord ◽

Aortic Dissection ◽

Medical Management ◽

Spinal Cord Ischemia ◽

False Lumen ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection

We report 2 cases of successful thoracic endovascular aortic repair (TEVAR) for acute type B aortic dissection (ABAD) complicated with spinal cord ischemia (SCI). Case 1. A 70-year-old gentleman found with an uncomplicated ABAD with false lumen occluded, developed SCI shortly after admission during the initial medical management. Cerebrospinal fluid drainage (CSFD) was initiated followed by emergent TEVAR. SCI improved, and the patient was discharged. Case 2. A 52-year-old gentleman developed uncomplicated ABAD with patent false lumen. 5 hours after admission, he developed SCI during the initial medical management. Emergent TEVAR was performed followed by CSFD, and the SCI improved before discharge. These cases prompted us to address prompt TEVAR for primary entry closure and true lumen dilatation with postoperative hypertensive management to relieve the dynamic obstruction of the segmental arteries responsible for the compromised spinal cord circulation in complicated ABAD.

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Intraoperative angiography for visceral arteries originating from false lumen

Asian Cardiovascular and Thoracic Annals ◽

10.1177/02184923211041457 ◽

2021 ◽

pp. 021849232110414

Author(s):

Shintaro Takago ◽

Satoru Nishida ◽

Yukihiro Noda ◽

Yu Nosaka ◽

Ryo Yamamura ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Circulatory Arrest ◽

False Lumen ◽

External Iliac Artery ◽

Acute Type ◽

Elephant Trunk ◽

Intraoperative Angiography ◽

Visceral Arteries ◽

Enhanced Computed Tomography

A 70-year-old man had an acute type B aortic dissection 9 years before his admission. The last enhanced computed tomography that was performed revealed an aneurysm that extended from the ascending aorta to the aortic arch, associated with a chronic aortic dissection, which extended from the aortic arch to the left external iliac artery. His visceral arteries originated from the false lumen. We performed a total arch replacement with a frozen elephant trunk in the hybrid operating room. Immediately after the circulatory arrest termination, using intraoperative angiography, we verified that the blood supply to the visceral arteries was patent.

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Management of a Compromised Frozen Elephant Trunk Due to Acute Type B Aortic Dissection

Vascular and Endovascular Surgery ◽

10.1177/1538574420949313 ◽

2020 ◽

Vol 54 (8) ◽

pp. 756-759

Author(s):

Amer Harky ◽

Robert K. Fisher ◽

Mark L. Field

Keyword(s):

Aortic Valve ◽

Aortic Dissection ◽

False Lumen ◽

Acute Type ◽

Type B ◽

Frozen Elephant Trunk ◽

Type B Aortic Dissection ◽

Elephant Trunk ◽

Thoracoabdominal Aorta

Purpose: To report a case who required a thoracic endovascular stenting (TEVAR) following the deployment of frozen elephant trunk due to false lumen expansion Case Report: A 47 years old male patient undergone emergency repair of acute type A aortic dissection in 2011 with bioprosthetic aortic root conduit. Seven years later he presented with moderate aortic valve disease and expanding chronic dissection of the aortic arch, therefore a redo operation with replacement of the prosthetic aortic valve, ascending aorta, total arch and deployment of frozen elephant trunk and he was discharged in good health. Several days post discharge he presented with new onset of chest pain and a new dissection involved the thoracoabdominal aorta was noted pressing on the true lumen and the frozen elephant trunk. Following a multi-disciplinary team meeting, TEVAR was deemed as a most appropriate approach and this was achieved successfully, and patient was discharged. At 1 year of follow up, he remains well and asymptomatic. Conclusion: Close imaging follow-up following deployment of a FET is mandatory. A new acute Type B aortic dissection distal to the FET, that causes false lumen propagation parallel to the stented portion, is a surgical emergency and further intervention mandated.

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Aortic Geometric Alteration Associated With Acute Type B Aortic Dissection: Angulation, Tortuosity, and Arch Type

Frontiers in Physiology ◽

10.3389/fphys.2021.708651 ◽

2021 ◽

Vol 12 ◽

Author(s):

Likun Sun ◽

Jiehua Li ◽

Lunchang Wang ◽

Quanming Li ◽

Hao He ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

False Lumen ◽

Ascending Aorta ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection ◽

True Lumen ◽

Factors Associated ◽

Geometric Factors

Background: Acute type B aortic dissection is a highly serious aortic pathology. Aortic geometric parameters may be useful variables related to the occurrence of acute type B aortic dissection (aTBAD). The aim of the study is to delineate the alteration in aortic geometric parameters and analyze the specific geometric factors associated with aTBAD.Methods: The propensity score matching method was applied to control confounding factors. The aortic diameter, length, angulation, tortuosity, and type of aortic arch of the aTBAD and control group were retrospectively analyzed via three-dimensional computed tomography imaging created by the 3mensio software (version 10.0, Maastricht, The Netherlands). The geometric variables of true lumen and false lumen in the descending aorta were measured to estimate the severity of aortic dissection. Multivariable logistic regression models were used to investigate the significant and specific factors associated with aTBAD occurrence. The area under the receiver operating characteristic curve (AUC) was used to estimate the performance of the model.Results: After propensity score matching, 168 matched pairs of patients were selected. The ascending aorta and aortic arch diameters were dilated, and the ascending aorta and total aorta lengths were elongated in aTBAD group significantly (P < 0.001). The ascending aorta and aortic arch angulations in the aTBAD group were sharper than those of the controls (P = 0.01, P < 0.001, respectively). The aortic arch and total aorta tortuosities were significantly higher in the aTBAD group (P = 0.001, P < 0.001, respectively). There were more type III arch patients in the aTBAD group than the controls (67.9 vs. 22.6%). The true lumen angulation was sharper than that in the false lumen (P < 0.01). The true lumen tortuosity was significantly lower than that in the false lumen (P < 0.001). The multivariable models identified that aortic arch angulation, tortuosity, and type III arch were independent and specific geometric factors associated with aTBAD occurrence. The AUC of the multivariable models 1, 2, 3 were 0.945, 0.953, and 0.96, respectively.Conclusions: The sharper angulation and higher tortuosity of aortic arch and type III arch were the geometric factors associated with aTBAD in addition to the ascending aorta elongation and aortic arch dilation. The angulation and tortuosity of the true and false lumens may carry significant clinical implications for the treatment and prognosis of aTBAD.

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