Delaminating aortic aneurysm

Delaminating aortic aneurysm is the sudden formation of a defect in the inner lining of the aortic wall, followed by the penetration of blood flow into the degeneratively altered middle layer, the formation of an intrahepatic hematoma and longitudinal dissection of the aortic wall.

The symptoms of vascular wall dissection are diverse and can mimic almost all cardiovascular, as well as neurological, and urological diseases. The clinical picture is determined by the localization of primary aortic fenestration and the extent of the dissection process.

Prosthetics are one of the most modern methods of treating aortic aneurysms. The essence of the operation is to install an endoprosthesis (stent graft), a tube made of fabric with a metal frame, into the lumen of the aneurysm. The edges of the tube are fixed in the aortic lumen above and below the site of the aneurysm. As a result, blood flow is localized inside the endoprosthesis, which isolates the aneurysmal sac from pressure on its wall. This procedure is performed for about 2 hours under local anesthesia, through a small incision and without blood loss.

Clinical case

A 50-year-old patient was admitted to the clinic with complaints of difficulty breathing, which increases in the prone position and during physical exertion, periods of unproductive cough, swelling of the legs, mainly the left. During the diagnostic search, dilation of the ascending thoracic aorta was diagnosed for the first time. Aortic dissection, DeBakey type III, Stanford type B, extending to the mouth of the left internal iliac artery. Aneurysms of both common iliac arteries.

An aortic aneurysm was a discovery during the examination.

The patient underwent MSCT of the thoracic and abdominal aorta and its branches. An enlargement of the ascending thoracic aorta, CT signs of aortic dissection extending to the mouth of the left aortic artery, and aneurysms of both aortic arteries were revealed.

A delaminated aortic aneurysm is an absolute indication for surgical treatment. The advantages and disadvantages of treatment methods (surgery and endoprosthetics) were explained to the patient if aortic lesion is detected.

A high-tech, minimally invasive operation was performed, endovascular prosthetics of the thoracic aorta and the left common, external iliac arteries. The operation was performed with a minimal incision, under local anesthesia. Stent grafts were implanted into the thoracic aorta and the common iliac and external iliac arteries, with overlapping sections of proximal and distal fenestration. This prevented the further spread of the subintimal channel. The operation was performed without complications, and the patient was discharged under observation.