Intimal dehiscence in the abdominal aorta following balloon fenestration for type B dissection

Manuel Maynar, Roman Rostagno, Tobias Zander, Zhong Qian, Rafael Llorens, Ignacio Zerolo, Wilfrido R. Castañeda

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Purpose: To report a case of intimal dehiscence associated with endovascular intervention in patients with aortic dissection. Case Report A 65-year-old man presented with a type B dissection extending to the level of the common iliac arteries. Two Talent stent-grafts were placed in the descending thoracic aorta to close the entry point, but 2 lumens remained. Three days later, abdominal pain prompted another imaging session, which demonstrated a large cylindrical filling defect in the abdominal aorta ("tube-in- tube") assumed to be a partially or completely dehisced intima. Fenestration marginally improved flow to the visceral vessels, and the patient improved clinically. However, 4 days later, recurrent ischemic symptoms prompted surgery; a complete dehiscence of the aortic intima starting at the descending aorta extended to the distal abdominal aorta. The aorta was resected, but the patient died from disseminated intravascular coagulation. Conclusions: Intimal flap dehiscence associated with an endovascular procedure in the management of aortic dissection is an uncommon complication. Early detection and prompt surgical intervention of such a complication could save the patient's life. Endovascular procedures are unlikely to resolve the hemodynamic problem caused by a dehisced, distally migrated, collapsed intima.

Original languageEnglish (US)
Pages (from-to)103-109
Number of pages7
JournalJournal of Endovascular Therapy
Volume12
Issue number1
DOIs
Publication statusPublished - Feb 1 2005

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Keywords

  • Abdominal aorta
  • Complication
  • Endovascular repair
  • Intimal dehiscence
  • Stent-graft
  • Thoracic aorta
  • Type B dissection

ASJC Scopus subject areas

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Maynar, M., Rostagno, R., Zander, T., Qian, Z., Llorens, R., Zerolo, I., & Castañeda, W. R. (2005). Intimal dehiscence in the abdominal aorta following balloon fenestration for type B dissection. Journal of Endovascular Therapy, 12(1), 103-109. https://doi.org/10.1583/04-1368.1