Acute type B Aortic Dissection Complicated by Acute Limb Ischemia: Case Report

2016 ◽  
Vol 7 (2) ◽  
pp. 97-99
Author(s):  
Hamid Jiber ◽  
Mauko Comlan Blitti ◽  
Abdellatif Bouarhroum
Keyword(s):  
Case Report ◽  
Aortic Dissection ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection

Role of the femorofemoral crossover graft in acute lower limb ischemia due to acute type B aortic dissection

Vascular ◽  
2013 ◽  
Vol 22 (2) ◽  
pp. 121-126 ◽  
Author(s):  
Lorraine Corfield ◽  
David J McCormack ◽  
Rachel Bell ◽  
Peter Taylor ◽  
John Reidy
Keyword(s):  
Aortic Dissection ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Lower Limb Ischemia ◽  
Thoracic Stent Graft

Acute limb ischemia due to type B aortic dissection is rare and continues to be a management challenge. A case series is presented here with the aim of assessing the outcomes of treatment with a femorofemoral crossover graft with or without thoracic stent graft insertion. This is a combined retrospective and prospective review of nine cases of acute lower limb ischemia secondary to acute type B aortic dissection. The presenting features, radiological findings, treatment and outcomes were reviewed. Five patients had a femorofemoral crossover graft (FFXO) alone, two an FFXO with a thoracic stent graft and the eighth a thoracic and iliac stent. The other case was initially treated conservatively but subsequently required an FFXO. The mean follow-up was 16 (3–51) months. A further two thoracic stents were placed during the follow-up period. Thus five out of nine patients (56%) required aortic stenting. This series suggests that an FFXO is a reliable treatment for acute limb ischemia due to type B aortic dissection. However, these patients are often complex with ischemia in other vascular beds and are at risk of subsequent aneurysmal dilation.

Don't get in a flap!: A case report of progression through the spectrum of an acute aortic syndrome

Vascular ◽  
2014 ◽  
Vol 22 (6) ◽  
pp. 454-457 ◽  
Author(s):  
Andrew MTL Choong ◽  
Saroj Das ◽  
Nicholas Mulrenan ◽  
Mohamad Hamady ◽  
Protip Bose
Keyword(s):  
Case Report ◽  
Chest Pain ◽  
Aortic Dissection ◽  
Vascular Surgery ◽  
Acute Type ◽  
Medical Team ◽  
Acute Aortic Syndrome ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Acute Aortic Syndromes

Purpose To present a single case that clearly demonstrates the progression through the whole spectrum of an acute aortic syndrome, from a solitary penetrating aortic ulcer (PAU) through to multiple PAUs with intra-mural haematoma (IMH) progression. The index images show that despite the clinical presentation of an acute type B aortic dissection, a classical dissection flap is never demonstrated in this patient and thus highlights the need for early input from vascular surgery for all potential acute aortic syndromes. Case report We present the case of a 71-year-old lady who attended the emergency department with hypertension and inter-scapular chest pain. Upon investigation with computed tomography aortography (CTA), she was found to have a solitary PAU only with minimal IMH. She did not demonstrate any classical radiological signs of acute type B aortic dissection. She was admitted under a medical team and her chest pain abated with no treatment. The treating medical team adjusted her anti-hypertensive medication and discharged her home with an urgent vascular surgical outpatient appointment for further follow-up and surveillance. We acknowledge that a preferred approach would have been, at least admission and close blood pressure monitoring, with a repeat CTA the next day. Two days later, she represented with further chest pain and on repeat CTA was found to have multiple PAUs and progression of the small IMH. She was then admitted under vascular surgery and subsequently transferred to the parent tertiary referral vascular surgical unit. Despite aggressive anti-hypertensive management, she had persistent intractable chest pain and was treated with a single thoracic stent graft. Completion angiography demonstrated total resolution of the PAUs. Conclusion This case along with index images demonstrates the whole spectrum of the acute aortic syndrome from a solitary PAU to multiple PAUs with IMH extension. Despite an eventual clinical picture of an acute type B aortic dissection, there was a notable absence of a classical dissection flap on any imaging. We recommend that all aortic pathologies should be at least discussed with and preferably managed by vascular surgeons. The absence of a classical dissection flap on imaging is not a contra-indication to emergent treatment with thoracic stent grafting and in select patients is actually the only therapy that will treat this pathology.

Severe Acute Type B Aortic Dissection Complicated by Acute Pancreatitis: A Case Report

2018 ◽  
Vol 47 ◽  
pp. 279.e19-279.e24 ◽  
Author(s):  
Jin Jie ◽  
Wu Yongfa ◽  
Wang Yuxin ◽  
Liao Mingfang ◽  
Qu Lefeng
Keyword(s):  
Acute Pancreatitis ◽  
Case Report ◽  
Aortic Dissection ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection

Acute limb ischemia associated with type B aortic dissection: Clinical relevance and therapy

Surgery ◽  
2006 ◽  
Vol 140 (4) ◽  
pp. 532-540 ◽  
Author(s):  
Peter K. Henke ◽  
David M. Williams ◽  
Gilbert R. Upchurch ◽  
Mary Proctor ◽  
Jeanna V. Cooper ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Clinical Relevance ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Type B ◽  
Type B Aortic Dissection

scholarly journals Arc of Buhler: A lifesaving anatomic variation. A case report

2020 ◽  
Vol 19 ◽  
Author(s):  
Schizas Nikolaos ◽  
Patris Vasilios ◽  
Lama Niki ◽  
Eleftherios Orestis Argyriou ◽  
Kratimenos Theodoros ◽  
...  
Keyword(s):  
Case Report ◽  
Aortic Dissection ◽  
Blood Supply ◽  
Anatomic Variation ◽  
Anatomical Variation ◽  
Celiac Artery ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Type B Dissection

Abstract The presence of malperfusion syndrome in cases of complicated acute type B aortic dissection is a negative predictive factor and urgent intervention is indicated. Anatomic variations, such as the Arc of Buhler, contribute anastomotic channels and can preserve the visceral blood supply. In this case report, we describe the overall management of a 54-year-old man who presented with a type B aortic dissection. Initially, conservative management was chosen, as indicated for an uncomplicated type B dissection, but the dissection deteriorated. Despite the fact that severe occlusion of the celiac artery was detected on Computed Tomography (CT) angiography, the Arc of Buhler anatomical variation was present, contributing adequate visceral blood supply. After considering this finding, the patient was treated effectively with thoracic endovascular aortic repair (TEVAR).

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