Page 20 - Virtual Vascular Vol 3

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Complicated Type B Aortic Dissection

with Acute Leg Ischemia

• Complicated aortic dissection with end-organ ischaemia is due to
static obstruction or dynamic obstruction

• Static obstruction occurs when the dissection flap extends
from the aorta into the side branches, and causes a mechanical

obstruction of the ostium of the branch, leading to formation
of secondary thrombus inside the branch and end-organ

ischemia

• Dynamic obstruction occurs when there is bowing or prolapse

of the false lumen’s flap toward the ostium of a major branch.

This is most apparent in systole of the cardiac cycle. When the
flap touches the ostium, the blood flow is impaired, causing

end-organ malperfusion. Dynamic obstruction is responsible

for about 80 % of the cases.

• Management includes admission to HDU or CCU with stringent blood

pressure control, and urgent endovascular intervention with
covering of the entry tear in the aortic arch with a stentgraft, +/-

stenting of the origin of the end-organ artery from the true lumen

(e.g. iliac artery), especially in cases of static obstruction.
Solaris™ Vascular covered stent

• In the absence of endovascular expertise or facilities, femoro-
femoral or axillo-femoral bypasses can be performed the salvage an
New generation endovascular stentgrafts are flexible, resistant to kinks, and ischaemic leg due to dissection.
more conformable to the target vessel. These self-expanding endografts

comprised of a thin multi-direction durable electrospinning PTFE membrane
encapsulating a Nitinol stent structure. It is used in the treatment of peripheral
occlusive or aneurysmal disease, either on their own or as adjunctive

procedures in complex endovascular aneurysm repair.
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