Thoracic Endovascular Repair of Rapidly Expanding False Lumen of Chronic Type III Aortic Dissection
Muhammad M Zubair, Yusuf M Chauhan, Charudatta S Bavare
Houston Methodist Hospital, Houston, TX
OBJECTIVES: The objective of this case presentation is to demonstrate a endovascular salvage procedure for rapidly expanding false lumen in a patient with chronic type III aortic dissection
METHODS: Preoperative computed tomogram angiography (CTA) demonstrated rapid aneurysmal expansion of the false lumen in a patient with chronic type III dissection. We utilized cone beam CT and fused the images with preoperative CTA. This allowed us to better delineate the anatomy of aortic arch and helped us determine the exact location of compromised aortic calcification of the true lumen leading to rapid aneurysmal expansion of the false lumen. This was found to be around 7-8 mm distal to the left subclavian artery. We initially placed a thoracic endograft distal to the left subclavian artery. Follow up angiogram demonstrated flow in the false lumen which was thought to secondary to type I endoleak. A proximal thoracic endograft extension was then placed.
RESULTS: Successful endovascular coverage of the chronically dissected thoracic aorta preventing extravasation into the rapidly expanding false lumen
CONCLUSIONS:
Compromised calcifications lining the true lumen can lead to rapid aneurysmal expansion of the false lumen with a potential for thoracic aortic rupture in a patient with chronic type III aortic dissection. Our case demonstrates recognition of the pathological process and successful treatment with a thoracic endograft.
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