Acute aortic dissection with critical stenoses of the true lumen treated by transluminal stent-graft placement and findings one year after treatment

Abstract

Clinical summary. A 54-year-old woman with a sudden onset of back pain was admitted to a satellite hospital of Mie University. Contrast-enhanced computed tomography (CT) revealed a DeBakey type IIIb, Stanford type B acute aortic dissection. The patient was treated medically. Nineteen days after admission, she had acute renal failure (blood urea nitrogen, 54 mg/dL; creatinine, 3.8 mg/dL) and left leg ischemia. CT disclosed severe stenosis of the true lumen at the level of the left renal artery. She was referred to Mie University Hospital for evaluation and treatment of acute aortic dissection. Her left femoral pulse was not palpable. The patient immediately underwent digital subtraction angiography (DSA), which showed that the intimal tear was located in the midportion of the descending thoracic aorta and that stenoses of the true lumen were located at the level of the diaphragm and distal to the level of the left renal artery. The left external iliac artery also had a critical stenosis. The true lumen of the right iliac artery was completely obliterated. However, the right leg was perfused by blood flow through the false lumen (Fig 1, A). Emergency transluminal stent-graft placement was subsequently performed. The stent graft was constructed of a selfexpanding, Gianturco stainless steel Z stent (Cook Critical Care, Inc, Bloomington, Ind) covered with a balloon-expandStanford type B acute aortic dissection is mainly treated medically. However, emergency surgery for type B dissection with rupture, impending rupture, end-organ ischemia, or some combination thereof is mandatory. Surgical outcomes are poor for patients with an acute type B aortic dissection with endorgan ischemia. Recently, transluminal stent-graft placement became an alternative for the treatment of aortic dissection.1,2 However, transluminal stent-graft placement for stenosis of the true lumen is not common, and the fate of a narrowed true lumen is not clear after stent-graft treatment. We report the case of a patient with acute type B aortic dissection with critical stenoses of the true lumen treated by transluminal stentgraft placement. We also discuss the effects on a narrowed true lumen 1 year after the treatment. ACUTE AORTIC DISSECTION WITH CRITICAL STENOSES OF THE TRUE LUMEN TREATED BY TRANSLUMINAL STENT-GRAFT PLACEMENT AND FINDINGS ONE YEAR AFTER TREATMENT