Aortic intussusception complicating diagnostic angiography: recognition and management

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Vascular Medicine

Background:

• Marfan syndrome predisposes individuals to aortic complications, including aortic dissection.
• Diagnostic catheterization carries inherent risks, particularly in patients with pre-existing aortic pathology.
• Acute type B aortic dissection presents a significant challenge for vascular interventions.

Observation:

• During diagnostic evaluation for Marfan syndrome and type B aortic dissection, a catheter inadvertently engaged the dissection entry tear.
• Catheter traction caused extensive intimal flap dehiscence, leading to intimal intussusception and occlusion of the true lumen.
• This complication resulted in critical obstruction of visceral and renal arteries.

Findings:

• A novel approach involving balloon fenestration of the intimal flap was performed.
• Supramesenteric stenting of the true lumen was utilized to manage the intimal intussusception.
• The intervention successfully decompressed the intimal flap and restored perfusion to the visceral and renal arteries.

Implications:

• This case highlights a rare but serious complication during aortic dissection evaluation.
• Demonstrates the efficacy of balloon fenestration and stenting in managing complex intimal flap complications.
• Suggests a potential endovascular strategy for similar iatrogenic aortic injuries.