Endovascular Solution in Case of Abdominal Aortic Dissection with Bilateral Lower Limb Ischemia in a Man Trampled by a Bull

Jaroen Cheewinmethasiri, Nuttapon Arayawdhikul, Boonsap Sakboon, Angsu Chartrungsan

Lampang hospital, Lampang, Thailand

Date, time and location: 2018.05.26 08:30, Exhibition area, 1st Floor. Zone – A

Abstract

Objective: We describe the endovascular treatment in a case of abdominal aortic dissection with bilateral common iliac artery ( CIA ) occlusion from dissection flap.

Method: Review technique of this case, as well as review of the literature

Results: A 73 year-old male present with acute limb ischemia both legs after trampled by a bull. CTA showed aortic dissection at distal abdominal aorta with dissection flap extended to bilateral CIA and Lt. external iliac artery ( EIA ) causing bilateral limb ischemia. We applied concept of CERAB in this case by using tube graft as a main body and bilateral kissing stent graft. Bilateral CFA were cut down and angiography was made. There were multiple re-entry sites in Lt.EIA & Lt.CIA, so we had to advance 0.035 hydrophilic guidewire and 5 Fr. catheter gradually after sporadically confirmed of angiography that we were in true lumen. After 0.035 hydrophilic guidewire and 5 Fr. catheter from bilateral CFA were in aorta, stiff guidewires were substituted. Tube graft of Endurant II was deployed in aorta, then bilateral kissing stent graft of Endurant II were deployed orderly. Stent graft was extended to Lt.EIA. Completion angiography showed completely resolution of aortic dissection and patent of bilateral Iliac artery. CTA at two-month after operation showed completely resolution of aortic dissection and patent of stent graft. At ten-month follow-up, ABI of Rt. Leg and Lt.Leg were 0.92 and 0.95, respectively.

Conclusion: Endovascular treatment is limb-salvage procedure with good early outcome.