Page 11 - Virtual Vascular Vol 6

Chronic Type B Dissection

A 47 year old patient had an acute Type B dissection
in 2014, treated conservatively. The entry tear as
seen on this CT was widely open, resulting in con-

tinuous perfusion of the false lumen. Six years later
the residual false lumen became aneurysmal and
reaches 6cm in diameter.

Aneurysm formation is a known late complication of
acute type B dissections, and can occur in 30-50%
of cases. In view of the young age of this patient,
an open repair of the proximal descending thoracic
aorta is the preferred choice.

There is increasing evidence that an early TEVAR
in the acute/subacute stage can prevent this com-
plication and improve long term survival in these
patients. TEVAR acts by covering the primary tear
and induce thrombosis and remodelling of the false
lumen.

Wong Wing Hung Type B.mp4

This is the CXR of the patient showing the mediastinal shadow.

Look at the CT scan video on the opposite page. Aside from the dissection tear and the aneu-
rysm, what other anatomical features do you notice that may complicate open / endovascular
repair in this patient?

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