Multiple Intimal Injuries of Chronic Aortic Dissection Observed by Non-Obstructive General Angioscopy

A 45-year-old woman was admitted for a follow-up of chronic aortic dissection for the first time in 4 years. Her only cardiovascular risk factor was smoking and her body mass index was 26 kg/m². Computed tomography angiography revealed aortic dissection with a double lumen from the dilated infrarenal aorta to the right common iliac artery (Figure A). Aortic angioscopy was performed to evaluate injuries of chronic aortic dissection using non-obstructive general angioscopy (Inter-tec Medicals, Osaka, Japan). In the infrarenal abdominal aorta, membranous separation of the intima was found and bleeding was demonstrated between the intima and the subintima (Figure B; Supplementary Movie 1). Another kind of bleeding was found at the site of the fluffy reddish surface (Figure C; Supplementary Movie 2). Membranous peeling in multiple directions was noted. At the white surface, subintimal laminar flow similar to wall painting was detected (Figure D). There were multiple communications between the true and pseudo lumens, and intimal injuries persisted for at least 4 years. A set of multiple fissures may be communications between the true and pseudo lumens instead of a single entry or re-entry. The patient was carefully followed up because the condition does not meet indications for surgery. Because aortic injuries persist for years, more cases are needed to demonstrate injuries and to identify signs of progression or rupture of aortic dissection for this fatal disease.

Figure.

(A) Computed tomography angiography at the level of the infrarenal artery. Angioscopic image in the infrarenal aorta. Locations 1, 2, and 3, correspond to parts (B), (C), and (D), respectively. (B) Membranous separation of the intima (dashed line) was found and bleeding was demonstrated between the intima and subintima (arrow). (C) Active bleeding was found at the site of the fluffy reddish surface. (D) The white surface appeared to be normal. Subintimal laminar flow similar to a wall painting was detected.

Disclosures

K.K. is the President of Inter-tec Medicals, Co. Ltd. S.K. is a technical consultant for Nemoto Kyorin-do Co. Ltd.

IRB Information

This study was approved by the local ethics committee of Osaka Gyoumeikan Hospital (20-0034).

Supplementary Files

Supplementary Movie 1. Angioscopic movie of Figure B.

Supplementary Movie 2. Angioscopic movie of Figure C.

Please find supplementary file(s);

http://dx.doi.org/10.1253/circrep.CR-20-0134