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J Thorac Cardiovasc Surg 2007;134:1342-1343
© 2007 The American Association for Thoracic Surgery

Brief Communication

Stent-graft repair for aortic type B dissections with insidious renal malperfusion

^a Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Pontchaillou, Rennes, France
^b Department of Cardiology, University Hospital Pontchaillou, Rennes, France
^c Department of Nephrology, University Hospital Pontchaillou, Rennes, France
^d Department of Radiology and Medical Imaging, University Hospital Pontchaillou, Rennes, France.

Received for publication May 22, 2007; accepted for publication May 30, 2007.

^_* Address for reprints: Jean Philippe Verhoye, MD, PhD, Department of Cardiac, Thoracic and Vascular Surgery, University Hospital Pontchaillou, Rue Henri Le Guillou, 35000 Rennes, France. (Email: jean-philippe.verhoye@chu-rennes.fr).

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

We report 2 cases of complicated type B aortic dissection, presenting clinically silent renal malperfusion with a nonenhancing right kidney and contralateral renal hypertrophy. After endovascular treatment, the reperfused kidney regained normal size and function and the hypertrophic contralateral kidney returned to a normal size.

Clinical Summaries

Patient 1
A 44-year old man was admitted for acute lower limb ischemia as previously reported.¹ A perioperative angiogram revealed a dissected appearance of the left common iliac artery. Perfusion was restored by stenting into the true lumen of the common iliac artery. A computed tomographic (CT) scan demonstrated complete type B aortic dissection. The celiac, superior mesenteric, and right renal arteries were malperfused because of dynamic compression of the true lumen by the false lumen. The right kidney was atrophic (95-mm long axis) and nonfunctioning on scintigraphy. The left kidney showed compensatory hypertrophy (142-mm long axis) (Figure 1, A). The patient had recent hypertension but had refused to comply with the recommended management of this hypertension.

View larger version (176K):   Figure 1. A, Patient 1. . . . [Full Text of this Article]