Successful Hybrid Treatment of Stent-Graft Migration Caused by Type B Aortic Dissection after Endovascular Aortic Aneurysm Repair: A Case Report

Abstract

Herein, we report a rare case of type B aortic dissection that occurred after endovascular aortic aneurysm repair (EVAR). A 66-year-old man underwent successful EVAR for an abdominal aortic aneurysm (AAA). Computed tomography (CT) 2 years after EVAR showed a type B aortic dissection with stent-graft migration and AAA expansion. Juxtarenal aortic expansion precluded simple stent-graft placement. He underwent hepato-spleno-renal bypass followed by stent-graft placement just below the superior mesenteric artery. Postoperative CT showed no endoleaks. This case reconfirms the importance of regular follow-up after EVAR and illustrates the usefulness of a hybrid approach.

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

“…7) However, TBAD after EVAR is a rare complication, with a reported risk of 0.5% estimated at a single-center study. 8) Although the exact mechanism underlying the development of EVAR has not yet been elucidated, spontaneous type B dissection and iatrogenic dissection are proposed to be two major etiologies ( Table 1). Iatrogenic dissection should be considered when dissection occurs during the perioperative period.…”

“…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.…”

“…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.…”

Hemodynamic performance within crossed stent grafts: computational and experimental study on the effect of cross position and angle

“…Clinically, stent graft migration remains a well-recognized complication [ 26 , 31 ]. According to the study by Li et al [ 18 ], migration behavior could be influenced by several factors including the iliac bifurcation angle, endograft size, blood pressure, endograft wall compliance, iliac branch curvature, and neck length.…”