Intimal Dehiscence in the Abdominal Aorta Following Balloon Fenestration for Type B Dissection

Abstract

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.

Aortic intimal intussusception during acute type B aortic dissection endovascular repair

“…It is mostly reported in type A aortic dissection, with few (1) in type B aortic dissection. Similar to other TEVAR-related AoII cases (3,5,6), this patient also suffered AoII during the endovascular repair of uncomplicated type B aortic dissection. His intima may be torn by a strong radial force after the releasing of thoracic aortic stent, resulting in occlusion of abdominal aorta and no signs of blood flow.…”

Two Cases of Aortic Intimal Intussusception During Endovascular Repair of an Acute Type B Dissection

“…One patient had an intimal detachment and intussusception that was discovered on postoperative day 3. 1 Despite reoperation with attempted fenestration and, ultimately, exploratory laparotomy, the patient succumbed to disseminated intravascular coagulopathy. Another patient presented with malperfusion and intimal intussusception that was recognized on imaging preoperatively.…”

“…An unusual complication, with few references in the academic literature and never in association with TEVAR, is intimal flap detachment with subsequent intussusception. 1–3 This is a potentially devastating intraoperative development that can prove fatal if not recognized and corrected quickly.…”

Uncovered stent implantation in complicated acute aortic dissection type B

“…13,16,17 Procedure-associated severe complications include aortic perforation and rupture. 26,27 In the past, we have not been impressed with the clinical results. In our current series, we used it in selected early cases, and again its effect was not reproducible.…”