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Case Reports
. 2009 Fall;18(3):143-6.
doi: 10.1055/s-0031-1278342.

Aortic dissection after open repair of an infrarenal aortic aneurysm

L Rodríguez Lorenzo  1 , A Romera Villegas, X Martí Mestre, Zoilo Madrazo Gonzalez, Cairols Castellote
Affiliations
Case Reports

Aortic dissection after open repair of an infrarenal aortic aneurysm

L Rodríguez Lorenzo et al. Int J Angiol. 2009 Fall.

Abstract

Introduction: A case of thoracic-abdominal dissection after open surgical exclusion of an infrarenal aortic aneurysm is presented.

Case presentation: A 62-year-old woman was diagnosed with an infrarenal abdominal aortic aneurysm with a rapid increase in maximal diameter. She underwent surgery for aneurysm exclusion by an end-to-end aortoaortic bypass with Dacron collagen (Intervascular; WL Gore & Associates Inc, USA). After 15 days, she was admitted to the emergency department with intense epigastric and lumbar pain. Computed tomography angiography with contrast revealed an aortic dissection with origin in the proximal bypass anastomosis and cranial extension to the thoracic aorta. The true lumen at the level of the eighth thoracic vertebra was practically collapsed by the false lumen. The celiac trunk, and the mesenteric and renal arteries were perfused by the true lumen. After the acute phase of the aortic dissection, surgical repair was planned. Two paths of false lumen were found - one at the thoracic aorta and the second in the proximal bypass anastomosis. Surgical repair comprised two approaches. First, a Valiant Thoracic stent graft (Medtronic Inc, UK) was implanted distal from the left subclavian artery, expanding the collapsed true lumen and covering the false and dissected lumen. Second, an infrarenal Endurant abdominal stent graft (Medtronic Inc) was implanted. This second device was complemented with an aortic infrarenal extension using a Talent abdominal stent graft (Medtronic Inc) in the infrarenal aortic neck to achieve a hermetic seal. The postoperative clinical course was uneventful, and her symptoms were completely resolved in six months.

Conclusion: Arteritis must be taken into account in young patients with high inflammatory markers. Covered stents and endoprosthetic devices seem to be effective methods to seal the dissected lumen.

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Figures

Figure 1)
Figure 1)
Aortic dissection (arrow) with the origin in the proximal bypass anastomosis
Figure 2)
Figure 2)
The true lumen collapsed by the false lumen (arrow)
Figure 3)
Figure 3)
The celiac trunk and mesenteric arteries perfused by the true lumen
Figure 4)
Figure 4)
Two paths of false lumen were found
Figure 5)
Figure 5)
Thoracic stent graft
Figure 6)
Figure 6)
Infrarenal stent graft
See this image and copyright information in PMC

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