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Case Reports
. 2021 Mar 18;13(3):e13971.
doi: 10.7759/cureus.13971.

Type A Thoracic Aortic Dissection Following Endovascular Repair of a Common Iliac Artery Aneurysm

Matthew P Wolfers  1 , Qian Yu  1 , Lisandro Montorfano  1 , Stephen J Bordes  2 , Terry King  3
Affiliations
Case Reports

Type A Thoracic Aortic Dissection Following Endovascular Repair of a Common Iliac Artery Aneurysm

Matthew P Wolfers et al. Cureus. .

Abstract

We discuss a rare case of acute Type A thoracic aortic dissection (TAAD) following endovascular aneurysm repair (EVAR) of a common iliac artery aneurysm, which likely resulted from complications due to aberrant anatomy. Valve replacement, ascending aortic arch graft, and entry tear suture repair were necessary to contain the TAAD. Postoperative computed tomography with angiography (CTA) demonstrated stable disease, and the patient remained asymptomatic. Open and endovascular repair of the descending abdominal aorta was avoided. Few cases in the literature report TAAD following EVAR. Detection and repair of the entry site was crucial for containing the TAAD.

Keywords: aortic dissection; aortic valve replacement; endovascular aneurysm repair; evar; type a acute aortic dissection.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Preoperative Computed Tomography (CT) Imaging
3.7 cm fusiform aneurysm of the right common iliac artery bifurcation with slight peripheral thrombosis. The aneurysm propagates into the proximal aspect of the right internal iliac artery. (A) axial abdominal CT image. (B) Coronal abdominal CT image with three-dimensional (3D) reconstruction. Orange arrow: common iliac artery aneurysm.
Figure 2
Figure 2. Postoperative Computed Tomography (CT) Imaging
An acute aortic dissection extends from the proximal thoracic aorta (A) to the abdominal aorta (B), just below the level of the superior mesenteric artery (C). Dissection flap extends to the bilateral common carotid and subclavian arteries. The proximal end of the endograft was partially collapsed due to the dissection (D). No endoleak or dissection was noted in the right iliac artery aneurysm (E). Proximal ascending aorta (F) and right subclavian origin (G) entry tears seemed to correspond to intraoperative findings. Red arrows: entry tears. Yellow arrow: external iliac artery. Green arrow: internal iliac artery. Blue arrow: collapsed proximal endograft. Orange arrow: aberrant right subclavian artery. (A) Sagittal thoracic CT image. (B) Coronal thoracic and abdominal CT image. (C) Axial abdominal CT image. (D) Sagittal lumbar CT image. (E) Axial abdominal CT image. (F,G) Axial thoracic CT image.
Figure 3
Figure 3. Six-Month Follow-Up Computed Tomography (CT) Imaging
CT imaging of the thorax showing aberrant right subclavian artery (green arrow) branching off from the distal aortic arch with a retroesophageal course. (A) Anterior thoracic CT image with three-dimensional (3D) reconstruction. (B) Posterior thoracic CT image with 3D reconstruction. (C) 3D anterior abdominal CT imaging showing a bifurcated stent graft of the right common iliac artery excluding the right common iliac artery aneurysm. (D) Coronal thoracic CT image showing the aortic valve in place (yellow arrow). (E) Sagittal lumbar CT image showing that the proximal end of the endograft remained partially collapsed (blue arrow). (F) Axial abdominal CT showing no evidence of endoleak in the right iliac artery. Red arrows: bilateral internal and external iliac arteries opacified by contrast.
See this image and copyright information in PMC

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