TY - JOUR
T1 - Rapid progression of discrete type A intramural hematoma
T2 - Prevention of a "procedure-related" complication by intraoperative transesophageal echocardiography
AU - Eggebrecht, Holger
AU - Schmermund, Axel
AU - Herold, Ulf
AU - Lind, Alexander
AU - Bartel, Thomas
AU - Buck, Thomas
AU - Martini, Stefan
AU - Kuhnt, Oliver
AU - Kienbaum, Peter
AU - Barkhausen, Jörg
AU - Jakob, Heinz
AU - Erbel, Raimund
PY - 2005/4/1
Y1 - 2005/4/1
N2 - Purpose: To report a case illustrating the utility of transesophageal echocardiography (TEE) before planned stent-graft placement for chronic type B aortic dissection. Case Report: A 64-year-old man with acute aortic syndrome and an 8-year-old interposition graft in the distal aortic arch for acute type B dissection was referred for dissection of the descending thoracic aorta down to the aortic bifurcation; the false lumen was dilated to 65 mm and was partially thrombosed. The ascending aorta showed discrete, eccentric, 4-mm wall thickening that was not considered clinically significant. Stent-graft closure of the entry tear in the proximal descending thoracic aorta was elected. However, as the endovascular procedure was about to commence, TEE showed striking eccentric thickening of the aortic wall of up to 18 mm. The endovascular procedure was stopped, as it was decided to urgently replace the ascending aorta. The next day, the patient underwent successful ascending aortic replacement and simultaneous antegrade stent-graft implantation over the descending thoracic aortic entry tear via the open aortic arch. The postoperative course was uncomplicated, and the patient was discharged 19 days after surgery. He remains well at 6 months after the procedure. Conclusions: Our case demonstrates that dissection of the ascending aorta may occur not only due to endograft-induced intimal injury, but may also occur due to underlying but undiagnosed or underestimated disease of the ascending aorta or arch. Besides procedural guidance, intraoperative TEE is a useful tool to detect such disease to avoid subsequent "procedure-related" complications.
AB - Purpose: To report a case illustrating the utility of transesophageal echocardiography (TEE) before planned stent-graft placement for chronic type B aortic dissection. Case Report: A 64-year-old man with acute aortic syndrome and an 8-year-old interposition graft in the distal aortic arch for acute type B dissection was referred for dissection of the descending thoracic aorta down to the aortic bifurcation; the false lumen was dilated to 65 mm and was partially thrombosed. The ascending aorta showed discrete, eccentric, 4-mm wall thickening that was not considered clinically significant. Stent-graft closure of the entry tear in the proximal descending thoracic aorta was elected. However, as the endovascular procedure was about to commence, TEE showed striking eccentric thickening of the aortic wall of up to 18 mm. The endovascular procedure was stopped, as it was decided to urgently replace the ascending aorta. The next day, the patient underwent successful ascending aortic replacement and simultaneous antegrade stent-graft implantation over the descending thoracic aortic entry tear via the open aortic arch. The postoperative course was uncomplicated, and the patient was discharged 19 days after surgery. He remains well at 6 months after the procedure. Conclusions: Our case demonstrates that dissection of the ascending aorta may occur not only due to endograft-induced intimal injury, but may also occur due to underlying but undiagnosed or underestimated disease of the ascending aorta or arch. Besides procedural guidance, intraoperative TEE is a useful tool to detect such disease to avoid subsequent "procedure-related" complications.
UR - http://www.scopus.com/inward/record.url?scp=20244362223&partnerID=8YFLogxK
U2 - 10.1583/04-1395.1
DO - 10.1583/04-1395.1
M3 - Journal articles
C2 - 15823074
AN - SCOPUS:20244362223
SN - 1526-6028
VL - 12
SP - 252
EP - 257
JO - Journal of Endovascular Therapy
JF - Journal of Endovascular Therapy
IS - 2
ER -