Visceral malperfusion after thoracic endovascular aortic repair for type B aortic dissection in a post-abdominal aortic grafting patient

Abstract

A 69-year-old woman with a history of graft replacement for abdominal aortic aneurysm developed a complicated type B aortic dissection that resulted in renal malperfusion after thoracic endovascular aortic repair (TEVAR).The primary entry tear was formed at the aortic arch and the false lumen (FL) continued to the abdominal aorta. The distal end of the FL formed a pouch-like blind alley above the suture line of the bifurcated abdominal graft. The true lumen (TL) was compressed and caused severe limb ischemia. The right renal artery (rRA) originated from the FL. The patient had initially undergone emergent axillofemoral bypass for limb malperfusion. Three weeks later, restenosis of the TL caused visceral malperfusion, and a huge thrombus formed in the FL pouch. TEVAR expanded the TL and restored visceral vascularization. However, the expanded TL compressed the thrombus in the blind alley to the rRA orifice and caused right renal malperfusion.The history of abdominal graft replacement may have increased the risk of a thrombotic event after TEVAR. Primary TEVAR may have helped prevent thrombus formation in the FL pouch.<Learning objective: This case report describes visceral arterial embolism induced by endovascular aortic repair (TEVAR) for type B aortic dissection in a patient with prior abdominal aortic grafting. A huge thrombus formed in the blind pouch of the false lumen (FL) above the graft suture line. TEVAR expanded the true lumen and the FL thrombus occluded a visceral artery with FL origin. Post-graft replacement has a risk of thrombus formation in the FL pouch and thrombus compression in visceral arteries.>