title: Unusual complication of aortic dissections: intimo-intimal intussusception.
abstract: Angiography with a pre-diagnosis of acute coronary syndrome was performed in a 76-year-old female patient presenting to another hospital with symptoms of chest pain and syncope. Upon determination of type III aortic dissection, the patient was referred to our clinic. On CT angiography, the ascending aortic diameter was 57 mm and no dissection flap was observed. There was a filling defect suggestive of intimo-intimal intussusception at the level of the aortic arch, occlusion of the left arteria carotid communis, and a double-channel aorta extending from the left subclavian artery to the iliac artery. On transoesophageal echocardiography, the ascending aorta was seen to be larger than normal and no dissection flap was observed. There were findings suggestive of haematoma and intimo-intimal intussusception at the proximal part of the aortic arch. The dissection flap causing occlusion in the vascular structures was resected. Supracoronary graft replacement of the ascending aorta was performed. Transoesophageal echocardiography is an invasive investigative method with high sensitivity and specificity for the diagnosis of intimo-intimal intussusception.
authors.affiliation: Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey. unsalvural@gmail.com.
authors.forename: Unsal
authors.initials: U
authors.lastname: Vural
authors.affiliation: Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey.
authors.forename: Ahmed Yavuz
authors.initials: AY
authors.lastname: Balci
authors.affiliation: Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey.
authors.forename: Ahmet Arif
authors.initials: AA
authors.lastname: Aglar
authors.affiliation: Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kizilay
authors.affiliation: Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Yekeler
authors.affiliation: Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey.
authors.forename: Abdullah Kemal
authors.initials: AK
authors.lastname: Tuygun
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D011391:Prolapse; D017539:Tunica Intima / Q000000981:diagnostic imaging* / Q000601:surgery