Retrograde ascending Stanford B aortic dissection complicating a routine infrarenal endovascular aortic reconstruction Apostolos T. Mamopoulos, MD, Thomas.

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Presentation transcript:

Retrograde ascending Stanford B aortic dissection complicating a routine infrarenal endovascular aortic reconstruction Apostolos T. Mamopoulos, MD, Thomas Nowak, PhD, Bernd Luther, PhD Journal of Vascular Surgery Volume 58, Issue 1, Pages 208-211 (July 2013) DOI: 10.1016/j.jvs.2012.10.111 Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 1 A, A preoperative computed tomography (CT) angiography shows the anatomic configuration of the infrarenal aorta. The infrarenal neck was 35 mm long, straight, and without thrombus, although a considerable degree of suprarenal angulation was present. B, The completion angiography showed complete exclusion of the aneurysm from the circulation. The arrow shows one of the right-sided suprarenal stents (the particular endograft had five of them) bent down into the aortic lumen, a fact that was not recognized intraoperatively. C, Postoperative CT angiography shows a retrograde aortic dissection beginning at the level of suprarenal fixation. The maximum diameter of the thoracic aorta was 57 mm at the level of the left subclavian artery. Journal of Vascular Surgery 2013 58, 208-211DOI: (10.1016/j.jvs.2012.10.111) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 2 A, A three-dimenstional reconstruction of the endograft clearly shows one of the right-sided crowns bent down, in a position perpendicular to the aortic lumen. B, A three-dimensional reconstruction shows the retrograde dissection beginning at the level of the deformed bare stent (white arrow). Journal of Vascular Surgery 2013 58, 208-211DOI: (10.1016/j.jvs.2012.10.111) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 3 A, A three-dimensional reconstruction shows the maximal progression of the dissection at 6 months postoperatively with a 33-mm-wide perfused false lumen. Because all of the aortic branches remained perfused by the true lumen, we decided against a secondary intervention, although the total diameter of the descending aorta was >60 mm at the time. B-D, The aortic dissection showed a favorable evolution with a maximum diameter of 65 mm and a partially perfused false lumen 2 months postoperatively (B), a maximum diameter of 66 mm and a partially perfused false lumen 6 months postoperatively (C), and a maximum diameter of 54 mm with a completely thrombosed false lumen at 1 year (D). Journal of Vascular Surgery 2013 58, 208-211DOI: (10.1016/j.jvs.2012.10.111) Copyright © 2013 Society for Vascular Surgery Terms and Conditions