Staged endovascular treatment for complicated type B aortic dissection

• Published in: Nature clinical practice cardiovascular medicine Vol. 2; no. 6; pp. 316 - 321
• Main Authors: Mossop, Peter J, McLachlan, Craig S, Amukotuwa, Shalini A, Nixon, Ian K
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 01-06-2005
• Subjects: Acute Disease; Adult; Aneurysm, Dissecting - diagnosis; Aneurysm, Dissecting - drug therapy; Aneurysm, Dissecting - surgery; Aorta, Thoracic - physiopathology; Aorta, Thoracic - surgery; Aortic Aneurysm, Thoracic - diagnosis; Aortic Aneurysm, Thoracic - drug therapy; Aortic Aneurysm, Thoracic - surgery; Atenolol; Back Pain - diagnosis; Benzimidazoles; Blood Vessel Prosthesis Implantation; Chest Pain - diagnosis; Humans; Male; Tetrazoles
• ISSN: 1743-4297; 1743-4300
• DOI: 10.1038/ncpcardio0224

A 40-year-old man presented with acute chest and back pain, hypertension and anuria. Two years previously he had been diagnosed with acute uncomplicated type B aortic dissection. Following conservative management, with aggressive antihypertensive therapy and analgesia, he was monitored with 6-monthly surveillance CT scans. These demonstrated a complicated type B dissection with renal and iliac malperfusion.
Multislice CT, transthoracic and transesophageal echocardiography, digital subtraction aortography.
Acute-on-chronic type B aortic dissection, complicated by aneurysmal dilatation of the thoracic aorta and visceral malperfusion.
Antihypertensive therapy; staged thoracoabdominal and branch vessel endoluminal repair (STABLE procedure), with stabilization of the dissection and rescue of renal function; CT imaging surveillance to monitor for any further complications.