Progression of Type B Aortic Dissection to Type A Dissection and Aortic Rupture Following Endoleak
Poster #: 072
Session/Time: A
Author:
Rishab Agarwal, BS
Mentor:
Jace Bradshaw, MD
Research Type: Case Report
Abstract
INTRODUCTION:
Retrograde Type A aortic dissection (RAAD) is a rare but devastating complication following thoracic endovascular aortic repair (TEVAR) for complicated Type B aortic dissection (TBAD).
CASE INFORMATION:
We present the case of a 44-year-old male with hypertension, end-stage renal disease (ESRD), and recent TEVAR for TBAD complicated by a Type II endoleak from the left subclavian artery. Despite surgical correction with subclavian ligation and bypass one month prior, he presented to the emergency department pulseless after a prehospital decline. Resuscitative efforts included airway management, high-quality chest compressions, and empiric treatment for hyperkalemia given his ESRD.
CLINICAL FINDINGS:
Point-of-care ultrasound revealed pericardial effusion concerning for tamponade and intra-abdominal free fluid. Multiple pericardiocentesis attempts drained 300cc of blood from the pericardium without hemodynamic improvement or resolution of the pericardial effusion, consistent with ongoing hemorrhage from suspected RAAD and aortic rupture. Despite aggressive resuscitation, the patient was declared dead after 35 minutes.
CONCLUSION:
This case underscores the potential relationship between prior endoleak and subsequent RAAD, highlighting the importance of vigilant surveillance after TEVAR and the need for emergency physicians to recognize these catastrophic complications for timely diagnosis and intervention.
Retrograde Type A aortic dissection (RAAD) is a rare but devastating complication following thoracic endovascular aortic repair (TEVAR) for complicated Type B aortic dissection (TBAD).
CASE INFORMATION:
We present the case of a 44-year-old male with hypertension, end-stage renal disease (ESRD), and recent TEVAR for TBAD complicated by a Type II endoleak from the left subclavian artery. Despite surgical correction with subclavian ligation and bypass one month prior, he presented to the emergency department pulseless after a prehospital decline. Resuscitative efforts included airway management, high-quality chest compressions, and empiric treatment for hyperkalemia given his ESRD.
CLINICAL FINDINGS:
Point-of-care ultrasound revealed pericardial effusion concerning for tamponade and intra-abdominal free fluid. Multiple pericardiocentesis attempts drained 300cc of blood from the pericardium without hemodynamic improvement or resolution of the pericardial effusion, consistent with ongoing hemorrhage from suspected RAAD and aortic rupture. Despite aggressive resuscitation, the patient was declared dead after 35 minutes.
CONCLUSION:
This case underscores the potential relationship between prior endoleak and subsequent RAAD, highlighting the importance of vigilant surveillance after TEVAR and the need for emergency physicians to recognize these catastrophic complications for timely diagnosis and intervention.