The Importance of Early Endovascular Intervention and Guideline-Based Cardiac Rehabilitation When Managing Type-B...

Most type-B aortic dissections are managed medically, except in certain situations such as descending aortic rupture, malperfusion, hypertension refractory to medical therapy (β-blockers and dihydropyridine calcium channel blockers), aneurysmal dilation, expansion, rupture, or impending rupture, where surgical intervention or an endovascular procedure is recommended as the primary method of treatment. However, there are scenarios where a type-B aortic dissection meets the criteria for surgical or endovascular intervention, but the patient is a poor surgical candidate due to the presence of numerous comorbidities (e.g., advanced age, hemodynamic instability, or the absence of a sufficient "landing zone" for intervention). In the following case report, we describe a 76-year-old female who presents with type-B aortic dissection extending to the distal left iliac artery. During her hospitalization, the patient was managed medically. Unfortunately, on day five of hospitalization, the patient developed sudden-onset chest pain followed by cardiac arrest shortly after her cardiac rehabilitation session. Considering how extensive her type-B aortic dissection was, it is hypothesized that due to physical exertion, there was an acute-onset retrograde expansion of the flap leading to sudden cardiac death. This emphasizes the importance of early surgical intervention as well as having a strict guideline regarding the level of physical exertion that such patients can undergo.