Endovascular Approach to Severe Acute Type B Aortic Dissection.

Area of Science:

• Cardiovascular Surgery
• Vascular Medicine
• Interventional Radiology

Background:

• Acute aortic dissection (AAD) is a life-threatening emergency requiring prompt diagnosis and management.
• Classification systems like Stanford and DeBakey aid in defining the extent of aortic dissection.
• Risk factors such as hypertension and smoking are crucial considerations in patients presenting with chest or back pain.

Observation:

• A 63-year-old male presented with symptoms suggestive of acute abdominal thoracic aortic dissection (DeBakey III, Stanford B) with extension to the left iliac artery.
• The patient exhibited signs of hypoperfusion, including reduced pulses in the lower limbs.
• Angiotomography confirmed the extensive nature of the dissection.

Findings:

• The patient underwent successful endovascular correction using Valiant and Viabahn endoprostheses.
• Stent grafts were implanted in the left renal artery to address dissection extension.
• Post-intervention, the patient demonstrated good recovery with preserved renal function and stable endoprosthesis positioning over three years.

Implications:

• Endovascular repair is an effective and less morbid approach for descending aortic dissections compared to open surgery.
• Aggressive follow-up, including medical management (e.g., beta-blockers) and surveillance, is vital for long-term patient survival and minimizing aortic stress.
• This case underscores the importance of early symptom detection and precise endovascular intervention for favorable outcomes in complex aortic dissections.