Body Region: Cardiovascular
Author: Christian Loewe, Vienna, Austria
1. Patient presentation
- A 82-year-old female patient with a known Stanford type B chronic aortic dissection was referred to our department for follow-up by CT angiography of the aorta.
- CT angiography demonstrated the chronic dissection with a proximal entry tear distal to the left subclavian artery as well as a progressive aneurysm at the level of the descending aorta, currently with a diameter of 6.1 x 4.9 cm (Figure 1a-c).
- Based on the absolute value of the aortic diameter and on the proven increase of 1.1 cm over the past year, there was an indication for thoracic endovascular aortic repair (TEVAR) by stent-graft implantation.
- Given the patient’s age and general condition, open surgery was considered contraindicated during a multidisciplinary conference and a combined treatment plan was established. To create a proximal landing zone, aortic arch rerouting was performed by transposition of both the left carotid and left subclavian artery. (Figure 2).
- TEVAR was carried out (Figure 3).
- Follow-up CT angiography after TEVAR was performed (Figure 4).