Circumferential type A aortic dissection with intimal intussusception

Oro, Raquel Sanchez; Muñoz, David Ibáñez; Artola, Javier Salceda; Martínez, Ignacio Quintana

doi:10.1016/j.jcct.2015.02.005

Cited by 5 publications

(5 citation statements)

References 4 publications

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“…After the first modern literature report in 1962, 7 there were approximately 61 aortic intimal intussusception (AII) studies reported until now, and most of them were case reports. Among them, 55 (90%) involved the natural progression of type A aortic dissection, 8–17 and only 1 reported the complication during transcatheter aortic valve replacement. 18 For TBAD, AII was also demonstrated in natural progression, blunt trauma, and iatrogenic cases from angiography catheter injury.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Stent-Graft-Induced Aortic Intimal Intussusception During TEVAR for Type B Aortic Dissection

Liu

Chen

et al. 2021

J Endovasc Ther

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Background: Aortic intimal intussusception is well described in the natural progression of type A aortic dissection. Only 3 cases of aortic intimal intussusception were reported to be related to thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection. In our study, we are reporting a rare but potentially fatal complication, the intraoperative stent-graft (SG)-induced aortic intimal intussusception (ISAII); this study reports a series of endovascular repair for ISAII cases. By presenting the ISAII definition, the diagnostic steps to rule out or to identify the condition, and the techniques to resolve it, we intended to raise the awareness of this severe complication, so that physicians can adapt to overcome the complications while performing TEVAR. Materials and Methods: ISAII was defined as the partial or circumferential disruption of the distal intimal flap as an intraoperative complication of endovascular treatment. From January 2014 to June 2020, 1,096 patients underwent TEVAR for Stanford type B aortic dissection at our hospital. Among them, 14 ISAII complications were witnessed. All these patients underwent endovascular repair for ISAII lesions, and their data were extracted for analysis. Results: The ISAII lesions were classified into 3 types according to their location in different aortic segments: type I, ISAII was limited within the intended SG coverage segment; type II, ISAII occurred after SG introduction or deployment, and the detached intimal flap extended beyond the intended SG coverage segment but did not affect the abdominal aortic visceral branches; type III, ISAII occurred during SG introduction or deployment, and the detached intimal flap descended to the abdominal aortic segment with visceral branches. Our results showed ISAII as a rare complication with an incidence of 1.28% (14/1096), and endovascular repair for all types of ISAII is an effective treatment. With a mean follow-up of 27.36 months (range 5–71 months), all the ISAII lesions were stable, and all the major aortic branches, SGs, and bare stents were patent. Conclusions: The management of this potentially devastating intraoperative complication relies on accurate diagnosis and prompt management. Our results suggested that endovascular repair for ISAII is effective and durable for correcting this complication. Graphical Abstract [Formula: see text]

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Section: Discussionmentioning

confidence: 99%

Intraoperative Stent-Graft-Induced Aortic Intimal Intussusception During TEVAR for Type B Aortic Dissection

Liu

Chen

et al. 2021

J Endovasc Ther

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“…We were unable to find any prior literature regarding AA III. 8 , 9 , 13 Traumatic circumferential intimal tears in the AA have been reported; however, diagnosis was generally later, involving complete aortoiliac or branch occlusion. 13 , 14 Absence of malperfusion in this patient initially led to interpretation of the diminished aortic caliber as hypotension in an atherosclerotic aorta rather than intimal injury, understandably as this unusual pattern of BAAI-associated dissection was not previously described.…”

Section: Discussionmentioning

confidence: 99%

“… 2 , 3 , 6 , 7 Intimointimal intussusception (III) has previously been reported only in the TA. 8 , 9 , 10 We report a case of circumferential dissection and III of the AA associated with thoracolumbar spinal fracture (TLSF) and a radiographically patent lumen. As part of surgical consent, our patient agreed for his deidentified case records and images to be used for this report.…”

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confidence: 99%

Blunt multifocal aortic injury with abdominal aortic intimointimal intussusception

Kalsi

Drucker

Salazar

et al. 2018

Journal of Vascular Surgery Cases, Innovations and Techniques

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Blunt abdominal aortic injury is an infrequent occurrence after blunt trauma. The majority of these injuries result from deceleration forces sustained in motor vehicle collisions. Effects of these forces on the thoracic aorta are well described, but associated spinal compression or distraction can also lead to injury of the affixed abdominal aorta. We present a case of multifocal blunt thoracic and abdominal aortic injury with circumferential abdominal aortic dissection, resulting in aortoaortic intussusception associated with a thoracolumbar spinal injury. The unique diagnostic challenge and subsequent successful endovascular management of a rare nonocclusive abdominal aortic intussusception are herein discussed.

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“…III is a rare complication of type A aortic dissections2 first described by Hufnagel et al in 1962 (as mentioned in Sanchez et al 1). The intima dissects and strips circumferentially and either rolls up into the aortic arch compromising the major branch vessels or prolapses backwards into the left ventricle, causing severe aortic regurgitation.…”

Section: Answer: Dmentioning

confidence: 99%

“…The echocardiograms and CT imaging show hallmarks of intimo-intimal intussusception (III): a short dissection flap in the aortic root, no visible flap in the ascending aorta and a curvilinear or windsock-like shadow in the aortic arch (see online supplementary videos) 1…”

Section: Answer: Dmentioning

confidence: 99%