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Staged endovascular treatment for complicated type B aortic dissection

Nature Clinical Practice Cardiovascular Medicine volume 2, pages 316–321 (2005)Cite this article

Abstract

Background A 40-year-old man presented with acute chest and back pain, hypertension and anuria. Two years previously he had been diagnosed with acute uncomplicated type B aortic dissection. Following conservative management, with aggressive antihypertensive therapy and analgesia, he was monitored with 6-monthly surveillance CT scans. These demonstrated a complicated type B dissection with renal and iliac malperfusion.

Investigations Multislice CT, transthoracic and transesophageal echocardiography, digital subtraction aortography.

Diagnosis Acute-on-chronic type B aortic dissection, complicated by aneurysmal dilatation of the thoracic aorta and visceral malperfusion.

Management Antihypertensive therapy; staged thoracoabdominal and branch vessel endoluminal repair (STABLE procedure), with stabilization of the dissection and rescue of renal function; CT imaging surveillance to monitor for any further complications.

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Figure 1: Multislice CT performed upon transfer of the patient to a teaching institution, 2 years after the initial diagnosis of aortic dissection.
Figure 2: Angiographic evaluation of the patient before and after endograft implantation.
Figure 3: Aortic model showing Zenith® TX2™ THORACIC TAA Endovascular Graft within the proximal descending aorta, in combination with the bare Z-stent system within the distal thoracic aorta.
Figure 4: Three-dimensional CT scan, performed 1 year after staged endovascular repair, demonstrating remodeling of the thoracoabdominal aorta and its branch vessels.
Figure 5: STABLE (staged thoracoabdominal and branch vessel endoluminal repair) procedure for the treatment of type B aortic dissection.

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Authors and Affiliations

  1. Departments of Cardiology and Medical Imaging,

    Peter J Mossop, Craig S McLachlan, Shalini A Amukotuwa & Ian K Nixon

  2. Cardiology and Medical Imaging,

    Peter J Mossop, Craig S McLachlan, Shalini A Amukotuwa & Ian K Nixon

  3. Department of Cardiothoracic Surgery, St Vincent's Hospital, Melbourne, Australia

    Peter J Mossop, Craig S McLachlan, Shalini A Amukotuwa & Ian K Nixon

Authors
  1. Peter J Mossop
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  2. Craig S McLachlan
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  3. Shalini A Amukotuwa
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  4. Ian K Nixon
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Correspondence to Peter J Mossop.

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The authors declare no competing financial interests.

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Mossop, P., McLachlan, C., Amukotuwa, S. et al. Staged endovascular treatment for complicated type B aortic dissection. Nat Rev Cardiol 2, 316–321 (2005). https://doi.org/10.1038/ncpcardio0224

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