Acute iatrogenic type A aortic dissection following thoracic aortic endografting Gabriele Piffaretti, MD, Giovanni Mariscalco, MD, PhD, Matteo Tozzi,

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Presentation transcript:

Acute iatrogenic type A aortic dissection following thoracic aortic endografting Gabriele Piffaretti, MD, Giovanni Mariscalco, MD, PhD, Matteo Tozzi, MD, Vito Domenico Bruno, MD, Andrea Sala, MD, Patrizio Castelli, MD, FACS Journal of Vascular Surgery Volume 51, Issue 4, Pages 993-999 (April 2010) DOI: 10.1016/j.jvs.2009.10.105 Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 1 Computed tomography-angiography during urgent hospital admission for acute aortic syndrome showing type B intramural hematoma (A). Six-month 3D-VR reconstruction follow-up control detected a penetrating ulcer (sketched line) of the distal portion of a type 3 aortic arch (B), protruding 16 mm (C). Journal of Vascular Surgery 2010 51, 993-999DOI: (10.1016/j.jvs.2009.10.105) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 2 Preliminary intraoperative angiography with 60° angulation (A) confirmed the origin of the ulcer (sketched line) just distally to the left subclavian artery. Final control after balloon angioplasty confirmed the EG correction and the absence of endoleak (B). Postoperative computed tomography-angiography: hemopericardium (arrow, C), true lumen compression (D), and entry tear at the proximal end of the EG (E). Journal of Vascular Surgery 2010 51, 993-999DOI: (10.1016/j.jvs.2009.10.105) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 3 Intraoperative finding: ascending and right pulmonary artery hematoma (A, arrow), opened arch with the intimal flap (B, arrow), proximal EG attachment site (C, sketched lines), and anastomosis between the vascular graft and the EG (D, arrow). Journal of Vascular Surgery 2010 51, 993-999DOI: (10.1016/j.jvs.2009.10.105) Copyright © 2010 Society for Vascular Surgery Terms and Conditions