Type a dissection after implantation of a stent-graft triggered by an intramural hematoma.

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists

PubMedID: 19456192

Zipfel B, Buz S, Laube H, Hetzer R. Type a dissection after implantation of a stent-graft triggered by an intramural hematoma. J Endovasc Ther. 2009;16(2):243-50.
PURPOSE
To describe an unusual case of multiple aneurysm disease in a patient who developed stent-graft-associated type A dissection.

CASE REPORT
A 72-year-old man presented with pericardial tamponade, which was treated with pericardial drainage. A small intramural hematoma of the ascending aorta was found originating from a proximal descending thoracic aortic aneurysm (TAA); he also had an infrarenal abdominal aortic aneurysm (AAA). After stabilization of the hematoma 7 weeks later, the TAA was repaired with a Relay stent-graft. Type A dissection followed after 3 days and acute rupture of the AAA 6 days later. Emergency surgical repair of both complications achieved successful outcome of an extended 3-stage procedure.

CONCLUSION
This case provides insight into the mechanisms that may contribute to stent-graft-associated type A dissection. Probably the previous separation of the aortic wall layers by the intramural hematoma triggered the complication, although the aorta appeared to have stabilized.