Utilization of Intravascular Ultrasound for the Evaluation and Management of Lower Extremity Malperfusion in a Type B Aortic Dissection

Abstract

Aortic dissection (AD) is a pathologic entity initiated from a tear in the intimal layer that allows blood flow between the intima and media, resulting in a separation of these layers into a true and false lumen. Subsequently, this flow within the false lumen encroaches on the true lumen flow and may cause malperfusion to vital organs or aortic rupture. On the basis of the anatomical location of the intimal tear, clinical presentation management may differ significantly. AD is classified as Stanford Type A or B based on the location of the intimal injury. In Stanford Type A, the site of injury is at the aortic root, which requires urgent surgical therapy. Type B are dissections that occur at or just distal to the takeoff of the left subclavian artery and in many situations can be managed medically by reduction in blood pressure.^1,2 In type B dissections that fail medical management or develop malperfusion, endovascular treatment has been used and described. ³ It provides a minimal invasive method; however, there are cases that may require open or a hybrid approach.^3,4