Collapsed endograft and lower limb ischemia from type B dissection repaired with thoracic endovascular aortic graft and iliac stenting: A case report and review of the literature

Peter V Cooke,Halbert Bai,Justin M George,Michael L Marin,Rami O Tadros

doi:10.1016/j.jvscit.2022.02.010

Abstract

The collapse of an abdominal aortic endograft is a rare event. We present the case of a 60-year-old man with an abdominal endograft who came to the emergency department with chest, back, abdominal, and lower extremity pain in addition to a cool left foot. On imaging, he was found to have a type B aortic dissection and a collapsed abdominal endograft. Subsequently, the patient was taken to the operating room and treated with a thoracic endovascular aortic repair, abdominal aortic cuff, and an iliac stent. Our study details this case and thoroughly reviews similar cases in the literature.

Highlights

The collapse of an abdominal aortic endograft is a rare event
We present the rare case of a TBADinduced collapse of an infrarenal endovascular aortic repair (EVAR), resulting in lower limb ischemia, successfully treated with Thoracic endovascular aortic repair (TEVAR), an abdominal aortic cuff, and iliac stenting
Similar cases of collapsed abdominal EVAR stent grafts from Type B acute aortic dissections (TBAD) have been sparsely reported in the literature

Summary

CASE REPORT

Informed consent was obtained for the publication and presentation of this case report and associated images. The infrarenal aortic graft and the left iliac distal landing zone were compressed by the false lumen of the dissection (Fig 2). From the left iliac limb, a glide wire could not be passed through the stent graft because it was crushed from the pressurized false lumen. A compliant balloon was used to open the abdominal graft (Fig 2), allowing the glide wire to pass on the left side. A Cook 32 Â 39 mm aortic cuff was deployed just below the renal arteries to provide additional radial force to the infrarenal device and prevent recollapse in the setting of false lumen thrombosis and remodeling. A completion angiogram demonstrated coverage of the dissection entry tear and patency of the infrarenal device with filling of the bilateral iliac limbs.

DISCUSSION

Alive Alive

Findings

CONCLUSIONS