Objective: Among all kinds of dissections, spontaneous infrarenal acute aortic dissections (SIAADs) are probably the rarest occurrence. Surgical treatment offers better results than medical therapy alone. In the era of developing endovascular techniques, strategies and technical problems challenge the physician on a daily basis. We present a simple and reproducible technique to deploy a bifurcated stent-graft in SIAADs. Methods: A 61-year-old man with history of hypertension, mild renal failure and COPD presented with acute onset of lower back-pain irradiated to the abdomen. No history of trauma was recorded. He had a raised BMI, severe hypertension, no signs of acute abdomen or leg ischemia. Abdominal echo color Doppler (ECD) showed a double-lumen aorta, with both chambers perfused and the entry tear localized below the origin of the renal arteries. A CT-scan confirmed the diagnosis and showed the dissection extending into the right common iliac, with intramural haematoma at the level left common iliac. The calibre of the infrarenal undissected aorta was 20 mm. The widest diameter of the abdominal aorta was 42 mm, without signs of impending rupture. Intravenous infusion of ß-Blockers and nitrate was started immediately, with immediate relief from abdominal and lower back pain. The patient was taken to ITU for close monitoring and then to the operating room two days later. The procedure was completed with a portable X-ray C-arm. A long 0.035 mm hydrophilic guidewire was inserted in the left groin and retrieved from the right groin, after a cross-over manoeuvre. Two catheters were inserted from each end onto the same guidewire, and then pushed to the level of the renal arteries. Finally, the guidewire was removed, leaving both catheters into the same lumen. A 24 mm AneuRx Gore® bifurcated endograft and a conic controlateral limb were deployed. The procedure was straightforward and complete exclusion of the false lumen was achieved. Results: The patient made an uneventful recovery and was discharged home four days later. A CT-scan at discharge showed complete resolution of SIAAD without endoleaks. The patient is doing well at 2 year follow-up. Conclusions: SIAAD is a rare event. In the recent era when endovascular therapy is imposing itself as an alternative to treat aortic disease, strategies and technical problems challenge the physician on a daily basis. An endovascular approach to address SIAADs may be complicated by malpositioning of the graft or iliac occlusion. We advocate to perform all endovascular procedures in the surgical theatre in order to promptly address all possible complications.
Bifurcated endovascular graft for spontaneous acute aortic dissections : description of a simple technique to help safe deployment / G. Bertoni, V.S. Tolva, P.G. Bianchi, L.V. Cireni, R. Casana. ((Intervento presentato al 59. convegno Meeting of the European society for cardiovascular surgery tenutosi a Cesme, Turkey nel 2010.
|Titolo:||Bifurcated endovascular graft for spontaneous acute aortic dissections : description of a simple technique to help safe deployment|
BERTONI, GABRIELE (Primo)
CIRENI, LEA VALERIA (Penultimo)
|Data di pubblicazione:||15-apr-2010|
|Parole Chiave:||acute aortic dissection ; abdominal diagnosis endovascular|
|Settore Scientifico Disciplinare:||Settore MED/22 - Chirurgia Vascolare|
|Enti collegati al convegno:||European society for cardiovascular surgery-ESCVS|
|Citazione:||Bifurcated endovascular graft for spontaneous acute aortic dissections : description of a simple technique to help safe deployment / G. Bertoni, V.S. Tolva, P.G. Bianchi, L.V. Cireni, R. Casana. ((Intervento presentato al 59. convegno Meeting of the European society for cardiovascular surgery tenutosi a Cesme, Turkey nel 2010.|
|Appare nelle tipologie:||14 - Intervento a convegno non pubblicato|