Tips and tricks in Endovascular Management of Complicated Type B Aortic Dissection . скачать в хорошем качестве

Tips and tricks in Endovascular Management of Complicated Type B Aortic Dissection .

Complicated aortic dissections occur in 25% of patients with acute type B dissection. A 62-year-old lady presented to the emergency room with sudden onset of severe back pain and cold sweating and bilateral lower leg numbness. Bilateral lower leg sensations were severely impaired. No pulsation over both feet could be detected by a handheld Doppler ultrasound probe. A CT scan revealed an acute Stanford type B aortic dissection with severe compromise in the visceral arteries and bilateral lower legs with a compressed true lumen of the infrarenal abdominal aorta. A zone 2 landing was required. In order to restore the patient’s perfusion in the shortest amount of time, we decided to maintain the patency of LSA by a chimney method. We use the pigtail advancing technique with the guidance of TEO to allow the wire in at all times to be in the true compressed lumen. We used Aptos to traverse from the true lumen to the false lumen to the left renal artery to fix the dynamic obstruction. After deployment of all devices, the entry tear was well sealed, and the innominate LCCA and LSA were patent. However, the infrarenal aorta still did not expand and we used an AFX Aortic graft. We use the PETTICOAT technique with J-TECH Aortic bare stent (40-36-130mm) to bridge the area between distal Gore graft and Proximal Infra renal Aortic Incraft Cuff. The patient recovered well and discharged home, 5 days postoperatively on dual antiplatelet We believe that a smooth alignment and Gore comfortable graft will preclude Any SINE in the future. Aorta had very favourable remodelling with significant true lumen expansion and false lumen regression, which were observed at different levels including the thoracic aorta beyond the LSA, T9 vertebra, T11 vertebra, and celiac artery. At the SMA level, false lumen regression of 65% and true lumen expansion of 160% were quite obvious. #Typebaorticdissection #acuteaorticsyndrome #stanfordtypeIII #Gore #Philips #Viabahn #Cordis #Endologicx #Endurant #Bostonscientific #Medtronic #Abbott #Excluder #COOK #BEVAR #FEVAR #CHEVAR #PEVAR #aptos #Lemaitre #Cryolife #Bolton #Terumo #Bentleyaorticstent #CTAG #AFX #INCRAFT #physicianmodifiedendovasculargraft #inspireMD #treo #JOTECHAORTICSTENT #pbranch #PioneerPluscatheter #Bentleyplus #jotech #tbranch #TOE #IVUS