Abdominal Aortic Endograft Collapse Due to False Lumen Radial Force of an Acute Type B Aortic Dissection

Hybrid repair strategies for acute type B aortic dissection complicating prior standard and complex endovascular aortic repair

Type B aortic dissection (TBAD) in the presence of an existing aortic endograft is a rare, but potentially catastrophic, event. False lumen pressurization and propagation leads to several failure modes. Endograft collapse can lead to spinal cord, visceral, or lower extremity ischemia, and rupture of a previously sealed aneurysm sac is often fatal. A successful treatment strategy must incorporate the patient's symptoms, urgency of intervention, extent of dissection, and the location and status of the existing graft. In this series, we present three cases of TBAD complicating prior endovascular aortic repairs-infrarenal, iliac branched, and thoracoabdominal branched endografts-successfully treated with tailored, hybrid interventions.

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

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.

A new process for customized patient-specific aortic stent graft using 3D printing technique

Endovascular aneurysm repair (EVAR) is a popular and effective treatment for descending aortic disease. However, the majority of existing coating stents used in EVAR are of a standard design which may not meet the size or structural requirements of different patients. Therefore, in this paper, we propose using 3D printing and controlled deposition as a patient-specific aortic stent graft manufacturing technique. The methodology involves the use of a rapid prototyping study sacrificial core-coating forming (RPSC-CF) technique to develop an aortic stent graft that consists of a film and metallic stent. Polyether polyurethane and nickel-titanium alloys were chosen due to their shape memory properties and good biocompatibility. The resulting customized stent grafts meet the demands of personalized therapy and invasive surgery, and perform well as demonstrated from burst pressure testing and the degree of radial support provided and radial support force tests, laying the foundation for precise aortic dissection treatment.

Acute Type B Aortic Dissection One Month After Fenestrated EVAR Procedure

Introduction

Acute aortic dissection after endovascular repair of an aortic aneurysm is a rare but serious condition, with potential complications that can result in the death of the patient.

Report

This is the case of a patient diagnosed with a type IV thoraco-abdominal aneurysm with involvement of both iliac arteries who underwent endovascular repair with a four fenestration device and a left iliac branch. One month after the procedure, the patient presented with a type B acute aortic dissection that extended from the left subclavian artery to the proximal stent of the fenestrated graft. This dissection was treated by thoracic endovascular aortic repair, and after a problematic post-operative period, the patient was discharged after 30 days.

Discussion

Occurrence of an acute aortic dissection after endovascular repair of an aortic aneurysm has rarely been reported in the literature. Development of these dissections has been related to factors such as excessive oversizing, use of devices with active fixation systems, or injuries during the procedure, although it is believed that the late onset would indicate that it was a de novo dissection. The presence of an aortic dissection can lead to the collapse and occlusion of the previous endograft and even to aortic rupture, and mortality in reported cases reaches 30%. The authors suggest that endovascular treatment should be considered in these patients.

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Aortic dissection in a patient with previous endovascular aneurysm repair is rare.

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Anatomic, device, and procedure factors could be the cause of this situation.

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Type B dissections could lead to collapse of the graft, sac growth, and rupture.

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Aggressive treatment must be considered to prevent serious complications.

Rare Case of Acute Type B Dissection Causing Complete Collapse of EVAR Stent

We describe a unique case of an acute type B aortic dissection in a patient with a history of a previously placed infrarenal aortic stent for an abdominal aortic aneurysm. The patient presented with a hypertensive emergency and left lower extremity ischemia, and imaging revealed complete collapse of the previously placed stent graft with extension into the iliac limbs. He underwent emergent endovascular intervention. When the false lumen was entered by puncturing the dissection plane with a sheath, immediate reexpansion of the stent graft was observed. The entry point of the dissection was covered with 2 overlapping stents, restoring flow within the true lumen. Although aortic stent collapse from acute type B aortic dissections is extremely rare, we demonstrate that endovascular release of the outflow obstruction and depressurizing the false lumen can resolve this dreaded complication.

Fatal Complications of New-Onset Complicated Type B Aortic Dissection After Endovascular Abdominal Aortic Aneurysm Repair: Report of 2 Cases and Literature Review

New-onset antegrade Stanford type B aortic dissection (TBAD) after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is rare. The extension of aortic dissection leads to various symptoms and affects the stent graft. Moreover, various symptoms may arise owing to a stent graft being present. We describe 2 cases of complicated acute TBAD occurring after EVAR, which were ultimately fatal. The case in which rupture occurred could not be treated and the patient died. In another case with bilateral lower extremity malperfusion caused by collapse and occlusion of the endograft, extra-anatomical bypass was performed. Although the collapsed endograft gradually re-expanded, the patient ultimately died because of multiorgan failure. We have reviewed the literature and analyzed the treatment of complicated TBAD after EVAR.

Acute Type B Dissection Causing Collapse of EVAR Endograft and Iliac Limb Occlusion

We describe a rare case of acute type B dissection (ATBDs) causing collapse of a previously placed infrarenal stent graft, resulting in acute limb ischemia due to left iliac limb thrombosis in a 59-year-old male. The patient presented with acute back and abdominal discomfort radiating to his back, bilateral buttock stabbing discomfort and left > right thigh and calf rest pain. CT angiography showed a spiral type B dissection with collapse of the proximal portion of the endovascular repair of aortic aneurysm (EVAR) device and left limb occlusion. Urgent treatment with thoracic endovascular aortic repair distal to the left subclavian covered the entry tear and redirected the majority of the flow to the true lumen leading to near immediate expansion of the proximal portion of the EVAR device. After surgical femoral control, balloon embolectomy of the occluded iliac limb was performed and the limb relined. His lower extremity ischemic symptoms resolved, and his abdominal and back pain dissipated. At latest 6-month follow-up, CT angiography shows an intact thoracic endovascular aortic repair stent graft and a widely patent EVAR stent graft, and the patient has no further abdominal, back, or leg symptoms. ATBD causing proximal abdominal EVAR collapse is an extremely rare presentation of false lumen pressurization and can be treated similarly to complicated type B dissection with the goal of restoring true lumen patency.

Acute Type B Aortic Dissection in a Patient with Previous Endovascular Abdominal Aortic Aneurysm Repair

Endovascular aortic repair (EVAR) was relatively safe, and became a widely performed procedure. If aortic dissection (AD) occurred in patient with previous EVAR, it could cause fatal complications like endograft collapse. Surgical treatment was limited in this situation for comorbidities and complex anatomies. Here we report a rare case of acute type B AD developed following trans-radial coronary intervention in a patient with previous EVAR of abdominal aortic aneurysm, which was treated with thoracic EVAR.

Type B Dissection Resulting in Acute Limb Ischemia in a Patient With a History of EVAR

Type B aortic dissection (TBAD) can be complicated due to visceral and limb malperfusion. We present the case of a patient with a TBAD 5 months after endovascular aneurysm repair (EVAR) for an infrarenal aortic aneurysm, which resulted in a right leg acute limb ischemia due to impingement of the EVAR from to the dissection. In the following discussion, we will review the literature and describe our technique for the treatment of this infrequent problem.