ABSTRACT
BACKGROUND: Acute descending thoracic aortic dissection is a life-threatening emergency. It is not often considered as the initial diagnosis in patients presenting with epigastric pain and could easily be missed in a busy casualty department. AIM: This case report is aimed to highlight the feasibility of the technique and the need for long-term surveillance following endovascular repair of acute thoracic aortic dissection. RESULTS: The patient presented with epigastric pain radiating to the interscapular region with a stable hemodynamic status. A computerized tomography (CT) scan demonstrated type B thoracic aortic dissection of the proximal descending thoracic aorta. A successful endovascular repair was carried out with uneventful recovery and follow-up CT scan six years after stent-grafting shows satisfactory position of the stent-graft, patent false lumen in the abdominal aorta perfusing the right kidney, and progressively enlarging diameter of the abdominal aorta. CONCLUSION: Thoracic aortic dissection should be considered as a differential diagnosis in patients presenting with epigastric and interscapular chest pain. Emergency endovascular repair of acute thoracic aortic dissection is feasible and relatively safe. Regular follow-up with CT scan is required to evaluate the long-term efficacy and identify the need for re-intervention.
Subject(s)
Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Emergency Medical Services , Microcirculation/surgery , Acute Disease , Aortic Dissection/pathology , Angiography , Aortic Aneurysm, Thoracic/pathology , Female , Humans , Microcirculation/pathology , Middle Aged , Tomography, X-Ray ComputedABSTRACT
Q fever is caused by Coxiella burnetii and often has an insidious clinical presentation. We describe a rare case of Q fever infection of an aortic graft presenting with pyrexia and constant severe midlumbar pain due to erosion of multiple vertebral bodies. After successful treatment with graft resection and extra-anatomic vascular reconstruction, the patient continues on lifelong antibiotic therapy. We also present regional Q fever epidemiologic data together with a review of all previously documented cases of Q fever infections of vascular prostheses.
Subject(s)
Blood Vessel Prosthesis Implantation/adverse effects , Coxiella burnetii/isolation & purification , Lumbar Vertebrae , Osteomyelitis/etiology , Prosthesis-Related Infections/etiology , Q Fever/complications , Spinal Diseases/etiology , Adult , Aged , Aneurysm, False/etiology , Aneurysm, False/microbiology , Aneurysm, Infected/etiology , Aneurysm, Infected/microbiology , Anti-Bacterial Agents/therapeutic use , Aortic Aneurysm, Abdominal/surgery , Device Removal , Female , Femoral Artery/microbiology , Humans , Lumbar Vertebrae/pathology , Magnetic Resonance Imaging , Male , Middle Aged , Osteomyelitis/microbiology , Osteomyelitis/pathology , Prosthesis-Related Infections/microbiology , Prosthesis-Related Infections/therapy , Q Fever/drug therapy , Q Fever/microbiology , Spinal Diseases/microbiology , Spinal Diseases/pathology , Tomography, X-Ray ComputedABSTRACT
Among various methods to achieve rapid occlusion of the aorta during endovascular repair for ruptured abdominal aortic aneurysm, particular emphasis is placed on two techniques that have been incorporated into our endovascular repair practice. The sheath-over-balloon technique (the Loan SOB technique) facilitates hemodynamic stability by transfemoral endovascular placement of an aortic occlusion balloon catheter to the infrarenal abdominal aorta. The balloon-ahead-of-graft technique (the Hornsby BAG technique) allows suprarenal hemodynamic control using a stent-graft system with a built-in balloon. The two techniques are simple, quick, and effective in achieving hemodynamic stability.
