Журнал клинических случаев

A Case of Re-Endovascular Repair in Acute Phase after Endovascular Aortic Repair for Acute Type B Aortic Dissection Complicated by Visceral, Renal and Lower Limb Malperfusion

Abstract

Mau Amako, Yuichi Morita, Masahiro Ohsumi, Shinji Kamiya, Hideaki Yamada, Mitsuru Fujii, Hiromitsu Teratani, Yuta Sukehiro, Go Kuwahara, Chihaya Itou, Hitoshi Matsumura, Noritoshi Minematsu and Hideichi Wada

We describe a case of re-endovascular aortic repair after endovascular aortic repair for acute type B aortic dissection, complicated by visceral, renal, and leg malperfusion. We performed endovascular aortic repair to cover the primary entry tear at the distal thoracic aortic arch in a 62-year-old male with visceral, renal, and leg malperfusion, after 4 days of conservative therapy. After the first operation, the pressure differential between upper and lower limbs disappeared. However, bilateral leg ischemia appeared at postoperative day 2. CT showed that the true lumen was severely compressed again by a thrombosed false lumen and two re-entries appeared at the level of the proximal celiac artery and infra-renal abdominal artery, respectively. The distal edge of the stent graft was intact with no new stent graft-induced entry. We once again performed endovascular aortic repair by means of thoracic and abdominal stent grafts covering the re-entry tears at the level of proximal celiac artery and infra-renal abdominal artery. After the procedure, the leg ischemia, renal ischemia and mesenteric ischemia improved, and the patient was transferred back to the local hospital without paraplegia.