title: Type a dissection after implantation of a stent-graft triggered by an intramural hematoma.
abstract: OBJECTIVE
  To describe an unusual case of multiple aneurysm disease in a patient who developed stent-graft-associated type A dissection.
  
  
  METHODS
  A 72-year-old man presented with pericardial tamponade, which was treated with pericardial drainage. A small intramural hematoma of the ascending aorta was found originating from a proximal descending thoracic aortic aneurysm (TAA); he also had an infrarenal abdominal aortic aneurysm (AAA). After stabilization of the hematoma 7 weeks later, the TAA was repaired with a Relay stent-graft. Type A dissection followed after 3 days and acute rupture of the AAA 6 days later. Emergency surgical repair of both complications achieved successful outcome of an extended 3-stage procedure.
  
  
  CONCLUSIONS
  This case provides insight into the mechanisms that may contribute to stent-graft-associated type A dissection. Probably the previous separation of the aortic wall layers by the intramural hematoma triggered the complication, although the aorta appeared to have stabilized.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany. zipfel@dhzb.de
authors.forename: Burkhart
authors.initials: B
authors.lastname: Zipfel
authors.forename: Semih
authors.initials: S
authors.lastname: Buz
authors.forename: Horst
authors.initials: H
authors.lastname: Laube
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation*; D006406:Hematoma / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D012086:Reoperation; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome