6533b82afe1ef96bd128c349

RESEARCH PRODUCT

Endograft repair of spontaneous infrarenal abdominal aortic dissection

subject

description

A 71-year-old man with a history of hypertension and a recent myocardial infarction experienced a sudden periumbilical and back pain. Abdominal tenderness was found at physical examination, with no changes in electrocardiogram and serial enzyme determinations. Computed tomographic angiography (CTA) showed a normal thoracic aorta, an infrarenal aortic dissection extending into the left common iliac artery and a contralateral iliac occlusive disease (A, Cover). Although antihypertensive therapy was administered, the patient had persistent pain; subsequently, he underwent endovascular repair with a bifurcated stent graft (Talent, Medtronic Ave, Santa Rosa, Calif) introduced via the left femoral artery through the introducer sheath. Because the contralateral iliac artery was not suitable for iliac limb deployment, an occluding covered stent was then positioned, and a 8-mm ePTFE femorofemoral bypass grafting was done to perfuse the right leg. The patient was discharged on postoperative day 4. A CTA postprocedural scan was performed with a multidetector device; a complete exclusion of dissection (B) and patency of femorofemoral bypass was observed. At 6 months, he remains symptom-free; the CTA scans with 3-dimensional volume rendering reconstruction show a normal morphology of abdominal aorta and femorofemoral reconstruction, with retrograde filling of right iliac arteries (C).