The Impact on Wound Healing and Major Amputation-free Survival in Patients With Isolated Below-the-Knee Arterial Disease After Angiosome-Directed Endovascular Revascularization

Abstract

been reported to occur secondary to malperfusion from complicated type B thoracic aortic dissection (TAD). We present diagnosis and endovascular treatment strategies for managing transient ischemic cauda equine syndrome.Methods: From 2015 to 2017, 92 patients with type B TAD were evaluated and underwent a variety of endovascular thoracic and abdominal aortic interventions. Of these, four patients presented with transient reproducible symptoms that only occurred with ambulation and included saddle region paresthesias, lower extremity weakness and paresthesias, and urinary incontinence, suggestive of cauda equine syndrome. All patients had spine magnetic resonance imaging, which was negative for spinal stenosis, compression, or infarction.Results: Detailed CTA evaluations indicated that in all patients the abdominal aortic true lumen had significant narrowing (mean diameter, 4.8 mm), and the dissections extended into both common iliac arteries compromising flow to bilateral internal iliac arteries. All four patients underwent endovascular interventions including aortoiliac septotomy and bare metal or stent graft placement in the aorta and iliac arteries. All patients experienced complete resolution of their transient cauda equina symptoms and have resumed normal activities.Conclusions: This is a first report of transient ischemic cauda equine syndrome resulting from type B TAD where the aortic true lumen and pelvic flow are significantly compromised. Endovascular interventions including septotomy and intraluminal stent/stent graft placements can improve aortic and pelvic flow and resolve these symptoms in select patients. This research focuses on better understanding complications of TAD that have in the past not been recognized. Our improved understanding of these complications enables us to better design procedures for patient treatment and management.