Philip J. Walker, FRACS. , Michael D. Dake, MD, R

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Presentation transcript:

The use of endovascular techniques for the treatment of complications of aortic dissection Philip J. Walker, FRACS *, Michael D. Dake, MD, R.Scott Mitchell, MD, D.Craig Miller, MD Journal of Vascular Surgery Volume 18, Issue 6, Pages 1042-1051 (December 1993) DOI: 10.1016/0741-5214(93)90560-9 Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, Aortogram with injection of false lumen (case 1). Left renal artery arises from false lumen. Right renal artery, which ariscs from true aortic lumen, is not visualized on false lumen injection. B, Spiral CT scan performed 10 months after renal artery dilatation and stent placement demonstrates that left renal artery is widely patent. Proximal artery, where stent is deployed (arrow), is larger than nonstented distal renal artery. Study was performed with Siemens Somaton Plus S scanner. (Courtesy of Geoffrey D. Rubin, MD, Stanford University Hospital.) Journal of Vascular Surgery 1993 18, 1042-1051DOI: (10.1016/0741-5214(93)90560-9) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 A, Angiogram demonstrates unsuspected type B dissection (case 2). External iliac artery, course of which is outlined by angiographic catheter (arrowheads), is totally occluded because of extrinsic compression by false channel. Celiac axis and SMA appeared to arise from false lumen, whereas main renal arteries (arrows) arise from true lumen. B, Intravascular ultrasound image. Miniature ultrasonic transducer catheter is represented by small, circular black lucency (bisected by two orthogonal axes delineated by white dots) and is positioned in false lumen. Hyperechoic septum (arrow) between smaller, compressed true lumen and large false lumen is clearly visible. Journal of Vascular Surgery 1993 18, 1042-1051DOI: (10.1016/0741-5214(93)90560-9) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 A, Plain radiograph shows series of five Palmaz stents deployed in right common and external iliac arteries. Angiographic catheter is seen passing through stented vessel. B, Completion angiogram demonstrates unimpeded flow in true lumen from aorta through stented right iliac artery into femoral artery. Oversizing is apparent in common iliac artery. C, Completion angiogram after deployment of Palmaz stents in true lumen of right and left renal arteries. There is unobstructed flow from aortic true lumen to both kidneys. Journal of Vascular Surgery 1993 18, 1042-1051DOI: (10.1016/0741-5214(93)90560-9) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Intravascular ultrasound image with probe positioned in aortic false lumen. Left renal artery (LRA) arises from compressed true lumen, whereas right renal artery (RRA), with dissection flap compromising its orifice, originates from false lumen. Journal of Vascular Surgery 1993 18, 1042-1051DOI: (10.1016/0741-5214(93)90560-9) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 A, Aortogram with injection of true lumen. CA and SMA filled well on injection. Neither renal artery was visualized, implying origin from false lumen. B, In spiral CT scan dissection plane (arrowheads) and relationship of visceral and renal vessels to two aortic lumens are clearly seen. SMA and right renal arteries originated from small, compressed anterior true lumen. Left renal artery arises from posterior and larger false channel. (Courtesy of Geoffrey D. Rubin, MD, Stanford University Hospital.) C, Spiral CT scan demonstrates widely patent stented left renal artery (arrow). Septum of dissection (arrowheads) is also visible. Journal of Vascular Surgery 1993 18, 1042-1051DOI: (10.1016/0741-5214(93)90560-9) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions