Regression of a descending thoracoabdominal aortic dissection following staged deployment of thoracic and abdominal aortic endografts.
OBJECTIVE
To describe the successful endovascular repair and regression of an extensive descending thoracoabdominal aortic dissection associated with thoracic and abdominal aortic aneurysms.


METHODS
An 83-year-old man presented with acute chest pain and shortness of breath. A descending thoracoabdominal aortic dissection that extended from near the left subclavian artery (LSA) to the right common iliac artery was found on computed tomography. Separate aneurysms in the thoracic and abdominal aorta were also identified. Staged endovascular procedures were undertaken to (1) close the single entry site and exclude the aneurysm in the thoracic aorta with an AneuRx thoracic stent-graft, (2) exclude the abdominal aneurysm and distal re-entry site with a bifurcated AneuRx endograft, and (3) treat a newly dilated thoracic segment between the LSA and first thoracic stent-graft. At 1 year, the false lumen had completely disappeared, the thoracic aneurysm had collapsed onto the endograft, and the abdominal aneurysm had shrunk by 30%.


CONCLUSIONS
The potential to treat extensive aortic dissections with the hope that they might regress is promising, but repair of highly complex lesions involving one or more aneurysms in addition to the dissection requires meticulous imaging studies both preoperatively and intraprocedurally.
White
Rodney A
RA
Division of Vascular Surgery, Harbor-UCLA Medical Center, Torrance, California 90509, USA. rawhite@ucla.edu
Donayre
Carlos
C
Walot
Irwin
I
Lee
James
J
Kopchok
George E
GE
D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D015607:Stents; D014057:Tomography, X-Ray Computed