Current management of acute type B aortic dissection

Figure 1 Intravascular ultrasound evaluation during thoracic stent grafting. The IVUS probe (image center) is seen confirming correct orientation within the true lumen. T: True lumen; F: False lumen; IVUS: Intravascular ultrasound.

Figure 2 Computed tomography angiogram of a patient presenting with acute type B aortic dissection. T: True lumen; F: False lumen.

Figure 3 3D reconstruction from a computed tomography angiography of a patient presenting with acute type B aortic dissection, highlighting the entry tear originating distal to the origin of the left subclavian artery. The dissection plan is seen to extend well into the abdominal aorta.

Figure 4 Suture line reinforcement with felt pledgets. A: Performing the posterior wall of the anastomosis first, in a “parachute” fashion. The suture travels from the prosthetic graft, to native aorta, then finally through the pledget; B: The suture line is tightened with the use of a nerve hook, and care taken to place the pledge on the outer surface of the aorta; C: Once the posterior wall of the anastomosis is completed, the anterior wall of the anastomosis is completed. The graft is somewhat invaginated within the aorta; D: The completed anastomosis, whereby the native aorta is buttressed on either end with pledget and graft. Source: “Long-term integrity of teflon felt-supported suture lines in aortic surgery,” by Strauch et al[9]. Copyright 2005 by Elsevier, reprinted with permission.

Figure 5 Remodeling after thoracic endovascular aortic repair. A: Follow-up 3D reconstruction from a computed tomography angiography of a patient who underwent TEVAR with adjunct superior mesenteric artery stenting for acute type B aortic dissection with malperfusion. There no evidence of endoleak or aneurysmal degeneration; B: Axial sections from same patient highlighting T expansion with evidence of false lumen thrombosis. TEVAR: Thoracic endovascular aortic repair; T: True lumen.