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

Havelka, George E.; Tomita, Tadaki M.; Malaisrie, S. Chris; Ho, Karen J.; Eskandari, Mark K.

doi:10.1177/1526602816644917

Cited by 9 publications

(8 citation statements)

References 12 publications

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“…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.…”

Section: Discussionsupporting

confidence: 77%

“…Once formed, it can cause malperfusion, posing a great threat to life. However, it is seldom reported during the thoracic endovascular repair (TEVAR) of uncomplicated type B aortic dissection (3). Here we report a case of AoII with malperfusion to raise the awareness of AoII during endovascular repair of aortic dissection.…”

Section: Introductionmentioning

confidence: 84%

“…AoII is a rare and potential life-threatening disease (2). It is usually secondary to aortic dissection and is developed by the detached intima from its origin (3). Once formed, it can cause malperfusion, posing a great threat to life.…”

Section: Introductionmentioning

confidence: 99%

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Aortic intimal intussusception during acute type B aortic dissection endovascular repair

Wang

et al. 2019

Ann. Transl. Med.

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Aortic intimal intussusception (AoII) is rare, especially during the endovascular repair of acute uncomplicated type B aortic dissection. Here we present a case of 47-year-old man who suffered AoII during the endovascular repair of type B aortic dissection. An abdominal aortic stent was inserted to recanalize the aorta, but failed. He was immediately transferred to our department from the local hospital. Computed tomography angiography confirmed the AoII and showed thrombus in the abdominal aortic stent. Hybrid operation was performed. Final angiography showed patency of the aorta. His postoperative period was uneventful and was discharged on the postoperative 8 th day. No complications happened during the 6 th month follow-up.

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Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 84%

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Aortic intimal intussusception during acute type B aortic dissection endovascular repair

Wang

et al. 2019

Ann. Transl. Med.

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“…18 For TBAD, AII was also demonstrated in natural progression, blunt trauma, and iatrogenic cases from angiography catheter injury. 19–23 Only 3 cases were related to TEVAR for TBAD, 24,25 and they were all distal to the SG. According to our results, although ISAII is a rare intraoperative complication, with an incidence of 1.28%, it is a major one, with catastrophic consequences if left undetected.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Stent-Graft-Induced Aortic Intimal Intussusception During TEVAR for Type B Aortic Dissection

Liu

Chen

et al. 2021

J Endovasc Ther

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Background: Aortic intimal intussusception is well described in the natural progression of type A aortic dissection. Only 3 cases of aortic intimal intussusception were reported to be related to thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection. In our study, we are reporting a rare but potentially fatal complication, the intraoperative stent-graft (SG)-induced aortic intimal intussusception (ISAII); this study reports a series of endovascular repair for ISAII cases. By presenting the ISAII definition, the diagnostic steps to rule out or to identify the condition, and the techniques to resolve it, we intended to raise the awareness of this severe complication, so that physicians can adapt to overcome the complications while performing TEVAR. Materials and Methods: ISAII was defined as the partial or circumferential disruption of the distal intimal flap as an intraoperative complication of endovascular treatment. From January 2014 to June 2020, 1,096 patients underwent TEVAR for Stanford type B aortic dissection at our hospital. Among them, 14 ISAII complications were witnessed. All these patients underwent endovascular repair for ISAII lesions, and their data were extracted for analysis. Results: The ISAII lesions were classified into 3 types according to their location in different aortic segments: type I, ISAII was limited within the intended SG coverage segment; type II, ISAII occurred after SG introduction or deployment, and the detached intimal flap extended beyond the intended SG coverage segment but did not affect the abdominal aortic visceral branches; type III, ISAII occurred during SG introduction or deployment, and the detached intimal flap descended to the abdominal aortic segment with visceral branches. Our results showed ISAII as a rare complication with an incidence of 1.28% (14/1096), and endovascular repair for all types of ISAII is an effective treatment. With a mean follow-up of 27.36 months (range 5–71 months), all the ISAII lesions were stable, and all the major aortic branches, SGs, and bare stents were patent. Conclusions: The management of this potentially devastating intraoperative complication relies on accurate diagnosis and prompt management. Our results suggested that endovascular repair for ISAII is effective and durable for correcting this complication. Graphical Abstract [Formula: see text]

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“…Tapered stent-grafts have satisfactory compliance with the diseased aorta and reduce stent axial force to the aortic wall, 2 thus potentially decreasing the risk of stent-related complications such as the intimal flap detachment in the reported cases. 1 Moreover, the distal stent-graft should terminate at a point in the true lumen with more normal aortic wall in order to obtain a stable distal landing site. The sleeve-like true lumen shown in the first of Havelka’s cases failed to provide a stable distal landing zone.…”

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confidence: 99%

Should a Tapered Stent Be Considered in TEVAR of Type B Dissection?

2016

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

Abstract: 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.

Cited by 9 publications

References 12 publications

Aortic intimal intussusception during acute type B aortic dissection endovascular repair

Aortic intimal intussusception during acute type B aortic dissection endovascular repair

Intraoperative Stent-Graft-Induced Aortic Intimal Intussusception During TEVAR for Type B Aortic Dissection

Should a Tapered Stent Be Considered in TEVAR of Type B Dissection?

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