Endovascular Repair of Abdominal Aortic Aneurysm With Chronic Dissection Using an Intravascular Ultrasound-Guided Reentry Catheter

Abstract

The incidence of aortic dissection is rare (approximately 10 cases per 1 million inhabitants' year), and reports of an associated aortic dissection within an abdominal aortic aneurysm (AAA) are anecdotal. Historically, such a dissection was treated by operation, but operative risks often excluded patients from intervention. An endovascular approach appears to be more advantageous, but concerns regarding “true” versus “false” lumens and the presence of an intimal flap make an endovascular intervention potentially hazardous. In this report, the authors describe a novel endovascular repair of an AAA with an Excluder device and the successful treatment of a concomitant abdominal aortic dissection using intravascular ultrasound and a Pioneer guided reentry catheter.

Keywords

IVUS reentry dissection endovascular AAA aortic aneurysm complication contralateral limb occlusion

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References

Jacobs DL , Cox DE , Motaganahalli R. Crossing chronic total occlusions of the iliac and femoral-popliteal vessels and the use of true lumen reentry devices. Perspect Vasc Surg Endovasc Ther. 2006;18:31-37.

Chuter TA , Gordon RL , Reilly LM , et al. Abdominal aortic aneurysm in high-risk patients: short- to intermediate-term results of endovascular repair. Radiology. 1999;210:361-365.

Zarins CK , White RA , Schwarten D. , et al. AneuRx stent graft versus open surgical repair of abdominal aortic aneurysms: multicenter prospective clinical trial. J Vasc Surg. 1999;29:292-305.

Prinssen M. , Verhoeven EL , Buth J. , et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. NEJM. 2004;351:1607-1618.

Chavan A. , Hausmann D. , Dresler C. , et al. Intravascular ultrasound-guided percutaneous fenestration of the intimal flap in the dissected aorta. Circulation. 1997;96: 2124-2127.

Song TK , Donayre CE , Walot I. , et al. Endograft exclusion of acute and chronic descending thoracic aortic dissections. J Vasc Surg. 2006;43:247-258.

Grudice R. , Frezzotri A. , Scoccianti M. Intravascular ultrasound-guided stenting for chronic abdominal aortic dissection . J Endovasc Ther. 2002;9:926-931.

Sampaio SM , Panneton JM , Brink JS , Andrews JC , McKusick MC , Gloviczki P. Aorto uni-iliac modification of a bifurcated stent graft for endovascular aneurysm repair: expanding the versatility of a modular device. Vasc Endovascular Surg. 2006;40:103-107.