Takayasu's arteritis and acute type B aortic dissection treated with a stent graft

Takayasu's arteritis is a large vessel vasculitis which usually involves the aorta and its first generation branches. Aortic dissection, however, is a rare manifestation of Takayasu's arteritis and for this reason optimum management in both short and long term is unknown.

This is a case of a 31-year-old female presenting with acute type B AD in association with underlying TA which failed to respond to conservative management and underwent thoracic stent grafting (TEVAR).

Despite successful coverage of the intimal breach in the thoracic aorta by TEVAR there were complications with delivery of the stent which required a conduit sutured to the right common iliac artery. Also post-TEVAR computed tomography showed a localised dissection of the origin of the left common carotid artery which may have been iatrogenic possibly due to the stiff guidewire used during delivery of the stent graft to the thoracic aorta.

The use of TEVAR for an acute type B AD in those with TA may be problematic. The fragility of the major arteries increases the likelihood of iatrogenic periprocedural complications and long-term surveillance is essential due to significant chance of further arterial complications in type B AD occurring in TA.