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Complicated type B aortic dissection causing ischemia in the celiac and inferior mesenteric artery distribution

Rana O Afifi1, Youwei Zhu2, Samuel S Leake3

  • 1Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, TX, USA Memorial Hermann Heart and Vascular Institute - Texas Medical Center, Houston, TX, USA.

Vascular
|October 10, 2014
PubMed

Insights

Acute type B aortic dissection (ABAD) with malperfusion has high mortality. This case highlights the risks of delayed intervention and the need for aggressive revascularization when endovascular repair fails.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Aortic Diseases

Background:

  • Acute type B aortic dissection (ABAD) poses significant mortality risks, particularly when complicated by visceral malperfusion.
  • Optimal management strategies for ABAD remain a subject of ongoing debate within the medical community.

Observation:

  • A 50-year-old male presented with ABAD, initially managed medically with symptom resolution and discharge on antihypertensives.
  • One month post-discharge, the patient was readmitted with symptoms indicative of visceral malperfusion, including abdominal pain, nausea, vomiting, and diarrhea.
  • Imaging revealed extension of the dissection into visceral arteries, causing occlusion of the celiac and superior mesenteric arteries (SMA).

Findings:

  • The patient underwent thoracic endovascular aortic repair (TEVAR) combined with SMA bypass grafting.
  • Despite surgical intervention, the patient developed extensive ischemia of the large bowel, liver, and stomach, necessitating bowel resection.
  • The patient ultimately succumbed to multi-organ failure following the complications.

Implications:

  • In select uncomplicated ABAD cases, thoracic endovascular aortic repair (TEVAR) may be a viable option.
  • Failure of TEVAR leading to visceral malperfusion warrants consideration of aggressive revascularization strategies targeting multiple visceral arteries.
  • This case underscores the critical importance of timely and appropriate intervention in managing complex aortic dissections to prevent catastrophic outcomes.

Keywords:
Complicated type B aortic dissectionmesenteric artery bypass graftingthoracic endovascular aortic repairthoracic endovascular aortic repair in aortic dissectionvisceral malperfusion

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