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Progressive Stanford B aortic dissection treated by acute stenting
  1. J A Wagner,
  2. G Wittenberg
  1. wagner_j{at}medizin.uni-wuerzburg.de

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A 48 year old woman (165 cm, 100 kg) with a known history of untreated hypertension was admitted to our intensive care unit with severe back pain primarily located between her shoulders. Blood pressure was 250/120 mm Hg. Transoesophageal echocardiography showed Stanford B aortic dissection with a typical entry distal to the origin of the left subclavian artery. Contrast computed tomographic scan revealed impaired perfusion of the left kidney provided by the false lumen. The dissection ended at the height of the left iliac artery. The patient stabilised under aggressive antihypertensive treatment with a mild increase in serum creatinine and sufficient urine output. The next day she was suddenly unable to move her legs and developed anuria. The mortality risk of an open operative procedure was estimated at 80–90%. Therefore, we decided to implant aortic stents (Medtronic, 30 mm) as soon as possible and intubated and ventilated the patient. Initial aortography reveals the beginning of the dissection distal to the left subclavian artery (panel A, arrow). Guided by transoesophageal echocardiography two stents were released. Radiographic control shows the result after the distal stent, which overlaps (panel B, arrow) the proximal one, has been set free. The arrowhead indicates the echocardiography probe. The first stent overlapped the origin of the left subclavian artery. The patient recovered from acute renal failure and maintained good renal function. There were no functional problems with the left arm which was perfused via retrograde flow in the left vertebral artery.


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