Aortic Septotomy: A Useful Technique for Managing Complex Thoracoabdominal Aortic Dissections
Glens Falls Hospital, Glens Falls, NY
INTRODUCTION: The persistent aortic septum in complex aortic dissections continues to challenge the efficacy of TEVAR and sometimes can result in unintended complications. METHODS: A 66 year-old patient presented with Type B Aortic Dissection (TBAD) with aneurysmal degeneration and underwent planned TEVAR with thoracic false lumen embolization. The procedure was uneventful and he was discharged home on postoperative day 1. Shortly thereafter, patient presented with significant bilateral buttock and lower extremity claudication and incontinence with minimal ambulation. These findings were consistent with transient cauda equine syndrome, which only occurred with ambulation. Neurosurgery ruled out spinal stenosis. CTA of abdomen and pelvis indicated residual infrarenal aortoiliac dissection that extended into bilateral internal iliac arteries.RESULTS: Patient underwent infrarenal aortic and bilateral iliac catheter and glide wire directed septotomy to improve pelvic perfusion.
CONCLUSIONS: In this movie presentation we highlight the importance of aortic septotomy as a useful adjunctive technique when managing complex thoracoabdominal aortic dissections.
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