Intussusception like lesion after fenestration in aortic type B dissection.

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Medical Imaging

Background:

• Marfan syndrome is a genetic disorder affecting connective tissue, predisposing individuals to aortic abnormalities.
• Stanford type B aortic dissection involves the descending thoracic aorta and can be life-threatening, especially during pregnancy.

Observation:

• A pregnant patient with Marfan syndrome experienced a Stanford type B aortic dissection.
• Following cesarean delivery, superior mesenteric artery obstruction necessitated an endovascular fenestration procedure.
• CT angiography revealed an unusual intussusception-like appearance of abdominal aortic layers post-fenestration.

Findings:

• The endovascular fenestration, using balloon and guidewire, potentially induced an aortic intussusception.
• Aneurysmal progression in the abdominal aorta required subsequent surgical repair and removal of intussusception material.
• The patient recovered well after the surgical intervention.

Implications:

• Guidewire manipulation during endovascular procedures may pose a risk of inducing intussusception in patients with aortic disorders.
• Fenestration procedures should be approached with extreme caution or avoided in Marfan syndrome patients due to inherent aortic fragility.
• This case underscores the importance of tailored management strategies for complex aortic conditions in high-risk populations.