Author + information
Patient initials or identifier number
A patient's NO. 10056319
Relevant clinical history and physical exam
A 65-year-old man with a complaint of “back pain and a chronic cough for 5 years”. Acute type B aortic dissection in 1994, conservative treatment with no progression of the disease for over ten years (1994∼2005). He did not have any radiologic examination from 2005 to 2013. CTA (2014) showed a progression of a dissection aneurysm. PE at admission: HR 62 bpm, BP (left) 130/90 mmHg, (right) 128/88 mmHg, weak respiratory sound in the left upper lung. No positive finding in the lab test or ECG, or UCG.
Relevant test results prior to catheterization
CTA showed primary entry tear closed to the left subclavian artery and a huge false lumen with total occlusion of the true lumen in the thoracic aorta. Celiac artery (CA) and right renal artery (RRA): false lumen. Superior mesenteric artery (SMA) and left renal artery (LRA): true lumen.
Relevant catheterization findings
Intraoperative angiography showed giant enlargement of false lumen and total occlusion of a true lumen in the thoracic aorta. Celiac artery (CA) and right renal artery (RRA): false lumen. Superior mesenteric artery (SMA) and left renal artery (LRA): true lumen
Through right femoral artery route, we tried to find out the true lumen but failed. Then, through left subclavian artery route, we tried again. In addition, with the help of the two routes, finally, the true lumen was identified and entered. We used a balloon to help to expand the true lumen with total occlusion of the thoracic descending aorta.
Then, introducer sheath was inserted into the true lumen. The endovascular stent released with intended occlusion of the left subclavian artery. In total, three stents used subsequently.
After stenting, left subclavian artery was intended occluded. No endoleak. Enlargement of the true lumen, and re-perfusion of celiac artery (CA) and right renal artery. Two-year CTA follow-up results showed no endoleak, completely thrombosis of false lumen and enlargement true lumen.