Case-based decision-making approach to false lumen occlusion in ruptured chronic type B aortic dissection

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Thoracic Surgery

Background:

• Chronic type B aortic dissection (TBAD) is a serious condition.
• Ruptured TBAD presents a life-threatening emergency demanding immediate medical attention.

Observation:

• A 65-year-old female patient with chronic TBAD experienced severe chest and epigastric pain.
• CT imaging revealed a ruptured false lumen (FL) in the proximal descending thoracic aorta.

Findings:

• Emergency thoracic endovascular aortic repair (TEVAR) was performed to seal the primary entry tear.
• Hemodynamic instability due to retrograde FL perfusion necessitated urgent FL occlusion with a custom Candy Plug.
• The patient recovered following the procedure and delayed hemothorax drainage.

Implications:

• This case demonstrates a successful stepwise management strategy for ruptured chronic TBAD.
• Further research is crucial to determine optimal timing and techniques for FL occlusion in such cases.
• Advanced endovascular techniques can be life-saving in complex aortic emergencies.