Fatal Complications of New-Onset Complicated Type B Aortic Dissection After Endovascular Abdominal Aortic Aneurysm Repair: Report of 2 Cases and Literature Review

Abstract

New-onset antegrade Stanford type B aortic dissection (TBAD) after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is rare. The extension of aortic dissection leads to various symptoms and affects the stent graft. Moreover, various symptoms may arise owing to a stent graft being present. We describe 2 cases of complicated acute TBAD occurring after EVAR, which were ultimately fatal. The case in which rupture occurred could not be treated and the patient died. In another case with bilateral lower extremity malperfusion caused by collapse and occlusion of the endograft, extra-anatomical bypass was performed. Although the collapsed endograft gradually re-expanded, the patient ultimately died because of multiorgan failure. We have reviewed the literature and analyzed the treatment of complicated TBAD after EVAR.

Type B Acute Aortic Dissection as a Perioperative Complication after an Endovascular Abdominal Aortic Repair

“…Conversely, most cases (17/20) of TBAD during the midterm postoperative period (2 weeks after EVAR) were complicated, including malperfusion, aneurysm expansion, or aneurysm rupture, which might require surgical or endovascular interventions. 2,3,6,8,10) Majority of these complicated cases had antegrade dissection from the distal arch of the left subclavian artery to the proximal stent graft. Finally, the prognosis is different depending on the onset of TBAD after EVAR.…”

“…Nomura et al reviewed 10 cases of spontaneous complicated TBAD after EVAR and found that collapse of stent graft and thrombosis occurred in 80% of these cases and suggested that they are fatal because the reentry is not formed by the presence of the stent graft. 2)…”

“…Several reports on TBAD after EVAR are avail-able, including cases in which the condition developed in the perioperative or midterm postoperative periods. [1][2][3][4][6][7][8][9] Herein, we described two cases of TBAD during the perioperative period of EVAR and our review of the literature related to this condition and analysis of the outcomes and treatment of perioperative EVAR.…”

Sudden endograft collapse due to type B aortic dissection after open conversion of endovascular aortic repair

“…at the origin of the left subclavian artery. Among 12 cases, 2 resulted in immediate mortality following rupture [ 4 ]. Of the 5 patients who underwent emergent TEVAR, 1 succumbed to non-disease-related intracranial haemorrhage [ 5 ].…”

“…Of the 5 patients who underwent emergent TEVAR, 1 succumbed to non-disease-related intracranial haemorrhage [ 5 ]. Furthermore, early mortality due to the necrosis of the visceral organs occurred in 2 of the 5 patients who underwent EAB [ 4 ]. Lower-extremity amputation due to intraoperative rupture was performed in 1 patient [ 3 ].…”