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CASE20191031_019
| ENDOVASCULAR - Aorta Disease and Intervention | |
| Emergent Thoracic Endovascular Repair for Acute Aortic Occlusion | |
| Shinnosuke Nomura1 | |
| Japanese Red Cross Wakayama Medical Center, Japan1, | |
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[Clinical Information]
- Patient initials or identifier number:
K.M.
-Relevant clinical history and physical exam:
A 76-year-old man who was treating chemotherapy for renal pelvis diagnosed thoracic aortic mild stenosis by contrast-enhanced CT a year ago. He was admitted emergently due to cardiac pulmonary arrest and improved by basic life support.
-Relevant test results prior to catheterization:
The contrast-enhanced CT image showed thoracic aortic total occlusion and severe pulmonary edema.
 miyake CT1 slow.mp4- Relevant catheterization findings:
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[Interventional Management]
- Procedural step:
It seemed that an acute thoracic aortic occlusion caused afterload mismatch and congestive heart failure, subsequently, emergent thoracic endovascular repair (TEVAR) was performed.A 6 Fr sheath was inserted from the left radial artery, and aortography was performed. Thoracic aortic sub-total occlusion was confirmed. Intervention system was constructed as following; 8 Fr sheath from right femoral artery and 6 Fr sheath from left femoral artery that was planned to protect superior mesenteric artery with filter.The 0.014¡± wire pass through the occluded aorta successfully, and intravascular ultrasound (IVUS) was performed. It showed atherosclerotic plaque or thrombus, not aortic dissection. However, Zenith TX alpha stent graft was deployed in descending thoracic aorta, the graft did not expand well, and blood pressure gradient between upper and lower limb was more than 50mmHg. Thus, another Zenith TX Alpha was deployed, and the balloon dilatation was performed. However, final IVUS did not show enough expansion of stent graft, blood pressure gradient disappeared.
0007102488__XA_20190815_7_7_0001.mpg 0007102488__IVUS_20190816_1_6_0001.mpg 0007102488__XA_20190815_48_48_0001.mpg- Case Summary:
On postoperative day 3, heart failure was improved. The follow up CT image on day 7 showed well expansion of stent graft at descending thoracic aorta compared to immediately after TEVAR. On day 30, the patient was discharged.TEVAR was effective for heart failure caused by acute thoracic aortic occlusion without dissection.
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