Endovascular Aortic Repair for Type B Acute Aortic Dissection with Leg Malperfusion

Kouki Nakashima＊	Yosuke Hari＊	Hisato Takagi＊
Tadashi Kitamura＊＊	Kagami Miyaji＊＊

（Department of Cardiovascular Surgery, Shizuoka Medical Center＊, Sunuto-gun, Shizuoka, Japan, and Department of Cardiovascular Surgery, Kitasato University School of Medicine＊＊, Sagamihara, Japan）

Leg malperfusion accompanied with type B acute aortic dissection（AAD）is reported to be an independent predictor for mortality. In such a case, though aortic replacement, extra anatomical arterial bypass or endovascular aortic repair（EVAR）can be selected, an appropriate treatment strategy has not been established yet. A 53-year-old woman was urgently hospitalized with sudden low back pain and right leg weakness, despite the right popliteal and anterior tibial arteries being palpable. Computed tomography（CT）revealed a type B AAD, and antihypertensive therapy was initiated. She complained of intermittent claudication during rehabilitation, and right leg ischemia with decreased ankle brachial pressure index（ABPI）was detected. The follow-up CT revealed the narrow true lumen of the right common iliac artery compressed by the thrombosed false lumen and the large entry of the aortic dissection in the terminal aorta. At the subacute phase of the aortic dissection, EVAR was performed. To expand the true lumen and exclude the entry, Y-shaped stent-grafts were implanted in the infra-renal aorta and the bilateral common iliac arteries. The postoperative course was uneventful. Postoperative ABPI returned to the normal range, and the intermittent claudication disappeared. In conclusion, EVAR should be considered in patients with type B AAD complicated with leg malperfusion.

 

Jpn. J. Cardiovasc. Surg. 50:69-72（2021）

Keywords：type B acute aortic dissection;leg malperfusion;endovascular aortic repair（EVAR）