title: Intimal dehiscence in the abdominal aorta following balloon fenestration for type B dissection.
abstract: OBJECTIVE
  To report a case of intimal dehiscence associated with endovascular intervention in patients with aortic dissection.
  
  
  METHODS
  A 65-year-old man presented with a type B dissection extending to the level of the common iliac arteries. Two Talent stent-grafts were placed in the descending thoracic aorta to close the entry point, but 2 lumens remained. Three days later, abdominal pain prompted another imaging session, which demonstrated a large cylindrical filling defect in the abdominal aorta ("tube-in-tube") assumed to be a partially or completely dehisced intima. Fenestration marginally improved flow to the visceral vessels, and the patient improved clinically. However, 4 days later, recurrent ischemic symptoms prompted surgery; a complete dehiscence of the aortic intima starting at the descending aorta extended to the distal abdominal aorta. The aorta was resected, but the patient died from disseminated intravascular coagulation.
  
  
  CONCLUSIONS
  Intimal flap dehiscence associated with an endovascular procedure in the management of aortic dissection is an uncommon complication. Early detection and prompt surgical intervention of such a complication could save the patient's life. Endovascular procedures are unlikely to resolve the hemodynamic problem caused by a dehisced, distally migrated, collapsed intima.
authors.affiliation: Hospiten Rambla, Las Palmas de Gran Canaria University, Santa Cruz de Tenerife, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Maynar
authors.forename: Roman
authors.initials: R
authors.lastname: Rostagno
authors.forename: Tobias
authors.initials: T
authors.lastname: Zander
authors.forename: Zhong
authors.initials: Z
authors.lastname: Qian
authors.forename: Rafael
authors.initials: R
authors.lastname: Llorens
authors.forename: Ignacio
authors.initials: I
authors.lastname: Zerolo
authors.forename: Wilfrido R
authors.initials: WR
authors.lastname: Castañeda
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000628:therapy*; D000800:Angioplasty, Balloon / Q000009:adverse effects* / Q000379:methods; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000628:therapy*; D001027:Aortography / Q000379:methods; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis; D012720:Severity of Illness Index; D015607:Stents / Q000009:adverse effects*; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000503:physiopathology; D014656:Vascular Surgical Procedures / Q000379:methods*