A Case of Thoracic Endovascular Aortic Repair Effective for Ileus and Renal Failure Complicated with Type B Acute Aortic Dissection

Abstract

A 47-year-old man was presented with back pain. The thoracoabdominal contrast CT scan showed a dissection from the origin of the left subclavian artery to the left common iliac artery. In addition, the dissection extended to the superior mesenteric artery (SMA) and the left renal artery. However, these blood flows were maintained, and no abnormalities were observed in the intra-abdominal organs. Stanford B acute aortic dissection was diagnosed, and conservative treatment was planned. On day 7 of admission, paralytic ileus due to the SMA ischemia was suspected through the X-ray and contrast CT scan. On day 10, his renal function deteriorated sharply. The contrast CT scan showed a progressive shrinkage of the true lumen and enlargement of the false lumen from the descending thoracic aorta to the abdominal aorta, ischemia of the ascending colon wall, and the left kidney infarction. On day 13 thoracic endovascular aortic repair (TEVAR) was conducted at the proximal part of the descending thoracic aorta. On postoperative day (POD) 3, the contrast CT scan showed an improvement in the blood flow of the colon and the left kidney. Though there were fever and infection treated by antibiotics, his postoperative course was generally good and he was discharged on POD 39.