Unusual Open Surgical Repair of a Type IB Endoleak and a Giant Symptomatic Aortic Aneurysm following Stent Grafting for Type B Aortic Dissection

Zsuzsanna Mihály, Csaba Csobay-Novák, L. Entz, Zoltán Szeberin

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Treatment of type IB endoleak after thoracic endovascular aortic repair (TEVAR) for post-dissection aortic aneurysm usually includes attempts of endovascular interventions using coils or plugs to occlude the false lumen or placement of a distal fenestrated endograft. Open conversion usually requires deep hypothermia and circulatory arrest with the associated increased mortality and complications. We present a case of a young patient with a 90 mm descending thoracic aneurysm caused by a chronic type B aortic dissection. A type II endoleak after TEVAR was successfully treated with left subclavian artery transposition. The patient had a rapidly increasing aortic aneurysm with a persistent type IB endoleak in spite of placement of an Amplatzer plug into the false lumen of the dissection. He developed progressive acute compression of the main stem bronchi by the aneurysm sac and his dyspnea worsened by an acute pulmonary embolism treated with anticoagulation. Adequate oxygenation could only be achieved with mechanical ventilation using a double-lumen endobronchial tube. A left thoracotomy was performed and the type IB endoleak was treated with bending of the distal aorta around the stent graft with a Dacron graft sleeve. Aortic clamping and circulatory support devices were avoided. The sac of the aneurysm was opened, a giant hematoma was evacuated, and aneurysmorrhaphy was performed to cover the stent graft. There was no residual endoleak and the bronchi were decompressed. The patient recovered after prolonged hospitalization and he was discharged home in good condition 24 days after admission. He returned to his normal activities and is asymptomatic 5 months later. Computed tomographic angiography showed decreased aneurysm sac, no evidence of endoleak, no residual pulmonary embolus, and no bronchial compression.

Original languageEnglish
Pages (from-to)305.e7-305.e10
JournalAnnals of Vascular Surgery
Volume30
DOIs
Publication statusPublished - Jan 1 2016

Fingerprint

Endoleak
Aortic Aneurysm
Stents
Dissection
Aneurysm
Thorax
Bronchi
Transplants
Polyethylene Terephthalates
Subclavian Artery
Thoracotomy
Embolism
Hypothermia
Pulmonary Embolism
Artificial Respiration
Constriction
Hematoma
Dyspnea
Aorta
Angiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Unusual Open Surgical Repair of a Type IB Endoleak and a Giant Symptomatic Aortic Aneurysm following Stent Grafting for Type B Aortic Dissection. / Mihály, Zsuzsanna; Csobay-Novák, Csaba; Entz, L.; Szeberin, Zoltán.

In: Annals of Vascular Surgery, Vol. 30, 01.01.2016, p. 305.e7-305.e10.

Research output: Contribution to journalArticle

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