A Case of Bilateral Lower Limb Ischemia Due to Endograft Collapse From Type B Acute Aortic Dissection

Endograft collapse caused by aortic dissection is rare, but it might cause critical complications and sometimes lead to death. We present a case of bilateral lower limb ischemia caused by endograft collapse due to type B acute aortic dissection (TBAD). A 70-year-old man with an abdominal aortic aneurysm (AAA) that was treated by endovascular aortic aneurysm repair (EVAR) 17 days prior returned to our hospital due to chest pain and bilateral lower limb paleness. Contrast-enhanced computed tomography (CT) showed an aortic dissection extending from the origin of the left subclavian artery to the terminal aorta. The main body of the endograft was compressed and the aneurysm was perfused by the false lumen. Additionally, the right leg of the endograft was occluded and the left one was collapsed. The patient was treated with axillo-bifemoral bypass without any lower limb sequela. However, contrast-enhanced CT performed at 2 months after the onset of the TBAD showed that the main body of the endograft was still collapsed, and the aneurysm was perfused by the false lumen of the dissection; thus, open AAA repair was performed. The postoperative course was uneventful and the patient was discharged without any complications. We successfully treated the patient with bilateral lower limb ischemia caused by endograft collapse due to TBAD after EVAR. The treatment should be considered on a case-by-case basis and an extra-anatomical revascularization is one of the good treatment options.