Circumferential Intimal Tear Causing Obstruction of the Aortic Arch: An Unusual Complication of Aortic Dissection

Reitknecht, Felice; Bhayana, J.N.; Lajos, Thomas Z.

doi:10.1016/s0003-4975(10)65864-x

Cited by 19 publications

(9 citation statements)

References 4 publications

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“…The clinical presentation is influenced by the position of the intimal tube. The antegrade intussusceptum may occlude the great vessels partially or completely, resulting in neurologic findings and/or asymmetric pulses as in our first case [4][5][6][7]. The retrograde intussusceptum oscillates into the ascending aorta in systole and into the left ventricle in diastole (Figs.…”

Section: Discussionmentioning

confidence: 82%

Radiological diagnosis and classification of antegrade and retrograde Stanford type A intimal intussusception

Sanders

Newman

Gara

et al. 2006

Int J Cardiovasc Imaging

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Intimal intussusception is an uncommon variation of aortic dissection, resulting from circumferential detachment and stripping of the intima in the setting of a Stanford type A dissection. The resultant tube of detached intima may prolapse either antegrade into the aortic lumen or retrograde into the left ventricular cavity. We classify these forms of dissection as antegrade and retrograde Stanford type A intimal intussusception. We present two cases with intimal intussusception and a review of the current literature. The majority of previous cases have been reported in the cardiology and cardiothoracic surgical literature, with few previous radiological reports.

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Section: Discussionmentioning

confidence: 82%

Radiological diagnosis and classification of antegrade and retrograde Stanford type A intimal intussusception

Sanders

Newman

Gara

et al. 2006

Int J Cardiovasc Imaging

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“…Circumferential aortic intimal tears permit complete intussusception of the inner wall cylinder. 16 Occlusion of branch vessels can occur by the same mechanism: they can be torn from the true lumen of the aorta as a result of dissection. Lack of a distal reentry may induce expansion of the false aortic lumen at the expense of the true channel.…”

Section: Discussionmentioning

confidence: 99%

Malperfusion of the Thoracoabdominal Vasculature in Aortic Dissection

et al. 1994

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Ischemic damage to vital organs supplied by the thoracoabdominal aorta greatly increases the overall risk of aortic dissection. Of 320 patients operated upon for aortic dissection since 1985, 33 (10.3%) underwent operations directed at the relief of malperfusion (15/158 acute type A; 9/18 acute type B; 4/78 chronic type A; 5/66 chronic type B). Organs affected were the kidneys in 32; the bowel in 20; and the spinal cord in 1, while critical lower extremity ischemia was present in 11 patients. In total, 64 vascular areas were affected. Fenestration of the dissecting membrane with or without infrarenal grafting was the procedure performed most frequently in 25, followed by replacement of the descending or thoracoabdominal aorta in 6, and bypass grafting or direct revascularization of individual side branches in 6. Six other operations targeted at the affected organs were done. Twenty-four patients underwent one-stage operation for malperfusion; in 11, early reoperation after primary aortic repair was necessary, while 2 patients were operated electively. Ten of 33 patients died in hospital, 7 of malperfusion-induced complications. Of three late deaths, one was related to sequelae of malperfusion. We conclude that immediate diagnosis and prompt relief of malperfusion offer the best prospects for patient survival. Membrane fenestration appears to be the method of choice for treating malperfusion in most patients, and must be directed to the level of aortic and/or side branch obstruction.

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14] Only in the case described by Karabulut et al 11 was the dissection continuous in the descending thoracic aorta. Circumferential intimal tears in type A dissections are said to predispose to intimointimal intussusception.…”

mentioning

confidence: 99%

“…Aortic intimal dehiscence, defined as intimal separation from the media over the entire circumference of the aorta, is an uncommon entity that typically occurs spontaneously as a complication of dissections starting in the ascending aorta. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Only in the case described by Karabulut et al 11 was the dissection continuous in the descending thoracic aorta. Circumferential intimal tears in type A dissec-tions are said to predispose to intimointimal intussusception.…”

mentioning

confidence: 99%

Intimal Dehiscence in the Abdominal Aorta Following Balloon Fenestration for Type B Dissection

Maynar

Rostagno

Zander

et al. 2005

Journal of Endovascular Therapy

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Circumferential Intimal Tear Causing Obstruction of the Aortic Arch: An Unusual Complication of Aortic Dissection

Cited by 19 publications

References 4 publications

Radiological diagnosis and classification of antegrade and retrograde Stanford type A intimal intussusception

Radiological diagnosis and classification of antegrade and retrograde Stanford type A intimal intussusception

Malperfusion of the Thoracoabdominal Vasculature in Aortic Dissection

Intimal Dehiscence in the Abdominal Aorta Following Balloon Fenestration for Type B Dissection

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