Two Cases of Aortic Intimal Intussusception During Endovascular Repair of an Acute Type B Dissection.
OBJECTIVE
To raise awareness of a previously undescribed complication of thoracic endovascular aortic repair (TEVAR) for aortic dissection that can lead to acute aortic occlusion and to highlight that early recognition, excision of the intimal flap, and open aortic repair can be lifesaving.


METHODS
Two patients underwent TEVAR for acute type B dissections complicated by abdominal malperfusion syndrome. During stent-graft deployment, the intimal flap circumferentially detached from its origin proximally with subsequent intussusception, leading to acute aortic occlusion. Both complications were recognized intraoperatively with immediate conversion to open aortic reconstruction and intimal flap excision. The first patient required an infrarenal aortobi-iliac bypass, while the second had an open aortic fenestration and bovine pericardial patch repair of the aortotomy. Their postoperative courses were uneventful. Follow-up imaging revealed excellent stent-graft approximation without endoleak and thrombosis of the false lumen.


CONCLUSIONS
Aortic intimal flap detachment and intussusception is a rare but potentially fatal complication of TEVAR for acute complicated aortic dissection. Quick diagnosis and a low threshold for conversion to open repair are critical in achieving a successful outcome.
Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
George E
GE
Havelka
Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Tadaki M
TM
Tomita
Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
S Chris
SC
Malaisrie
Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Karen J
KJ
Ho
Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Mark K
MK
Eskandari
D000208:Acute Disease; D000328:Adult; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D057510:Endovascular Procedures / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000637:transplantation; D012039:Regional Blood Flow; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
aortic intima; complications; conversion; intussusception; thoracic endovascular aortic repair; type B dissection