Southern Association For Vascular Surgery

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Endovascular Repair of Ruptured Type B Aortic Dissection
Chirag Buch, Esther Bae, Lalithapriya Jayakumar, MD
University of Texas Health Science Center SA, San Antonio, TX

Introduction: Type B aortic dissection is life-threatening condition associated with high morbidity and mortality. The presentation of type B aortic dissection is often a male patient in his 60ís with a history of smoking and hypertension, that presents with the chief complaint of sudden sharp chest and/or back pain. We present a video case report of an endovascular repair in an immediate post-partum female with a ruptured type B aortic dissection. Methods: 31 y/o female presented as a transfer by air to our hospital for a thoracic aortic rupture. She had undergone an emergency C-section for fetal decelerations and contractions secondary to eclampsia at 38 weeks gestation 12 hours prior to transfer. At the outside hospital, she became hypotensive post operatively with subsequent workup including a CT chest with contrast demonstrating a thoracic aortic dissection and large L hemothorax. She arrived intubated on pressors. She had a chest tube placement with evacuation of 750 mL sanguinous fluid in the resuscitation area. She was taken emergently to the operating room for repair. Results: Her CT demonstrated a type B aortic dissection extending from the left subclavian artery to the bilateral iliac arteries. Her celiac, SMA, and left renal were off of the true lumen. Her right renal artery originated from the false lumen of the dissection. She underwent IVUS evaluation of her aorta to navigate the true lumen, followed by a thoracic aortogram demonstrating an area of obvious rupture in the mid descending aorta. A thoracic endograft (CTAG - W.L. Gore & Associates, Newark, DE) was deployed with subsequent angiogram demonstrating persistent bleeding from the false lumen. The IVUS was then used to navigate into the false lumen and an Amplatzer plug (Abbott vascular, Santa Clara, CA) was placed. Conclusion: Completion aortogram demonstrated complete resolution of the rupture with no further extravasation of contrast. She received 6 units PRBCs, 6 Units FFP, and 4 units of platelets throughout her perioperative resuscitation. The patientís post-operative course was uneventful and she was discharged to rehab post-operative day #11.


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