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J Thorac Cardiovasc Surg 2004;128:634-636
© 2004 The American Association for Thoracic Surgery

Brief communication

Distal aortic arch aneurysm after endovascular stent graft repair for type B chronic aortic dissection

Claudio F. Russo, MDa, Andrea Garatti, MDa,*, Maurizio Puttini, MDa, Ettore Vitali, MDa

a Department of Cardiovascular Surgery, "A. De Gasperis," Niguarda Ca'Granda Hospital, Milan, Italy

Received for publication January 9, 2004; revisions received February 12, 2004; accepted for publication March 16, 2004.

* Address for reprints: Andrea Garatti, MD, Department of Cardio-Thoracic Surgery, "A. De Gasperis," Ospedale Niguarda Ca'Granda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
agaratti@tiscali.it

The first 20% of the full text of this article appears below.

Endovascular stent grafting of the descending thoracic aorta has recently become a valid and safe alternative to surgical treatment of type B aortic dissection, even though it has been related to some complications, such as graft displacement, aortic injury, paraplegia, embolization, stroke, and left arm ischemia. In these cases, surgical management can be troublesome, particularly when displacement of the graft and proximal endoleak involve the aortic arch or the origin of the supra-aortic vessels.

Clinical summary

A 68-year-old man came to the emergency room with cramplike pain in his right leg. He was obese and a heavy smoker, with a history of high blood pressure and mild chronic renal failure. General examination was unremarkable. Computed tomographic (CT) scan showed an extensive chronic type B aortic dissection with an aortic diameter greater than 6 cm. Transesophageal echocardiogram confirmed the diagnosis and showed a wide intimal tear with no involvement of the left subclavian artery. Because of stable conditions and the lack of complications, the patient did not undergo urgent surgery but was managed medically. At aortography, aortic dissection extended from the distal aortic arch to the femoral vessels; all visceral branches arose from the true lumen, but both superior mesenteric and left renal arteries were partially compressed by the false lumen. An anomalous origin of the supra-aortic vessel was detected with a common origin of the left carotid and subclavian arteries (left brachiocephalic trunk). Considering the large dimension of the thoracic aorta and . . . [Full Text of this Article]






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