Case Report Spontaneous isolated dissection at renal upper abdominal aortic: a rare case report

Jian-Ping Liu, Feng-En Liu, Qing Duan, Rong Ye, Jun-Qi Xiao
2015 Int J Clin Exp Med   unpublished
Arterial dissection is defined as a cleavage of the arterial wall caused by intramural hematoma. Isolated extra-aortic arterial dissection has been reported in renal and carotid arteries in few literatures but suprarenal aorta dissection associated with retrograde formation of a giant descending thoracic aneurysm is considered very rare. We present a quite unusual case of suprarenal aorta dissection associated with retrograde formation of a giant descending thoracic aneurysm sparing both renal
more » ... sparing both renal and mesenteric vessels, without any branch vessel involvement or visceral damage. Because of the patient's persistent epigastric pain, endovascular celiac artery stent implantation was performed with 3 multiple overlapping uncovered stents. Twelve months after the procedure, computed tomo-graphic angiography (CTA) of the abdomen showed patency of both celiac stents with thrombus formation in the retrograde dissection sac, and the patient remained asymptomatic. This case and others in the medical literature suggest that endovascular treatment can be feasible in symptomatic patients with spontaneous isolated dissection at renal upper abdominal aortic. A 43-year-old man was admitted to our hospital because of suddenly persistent, dull pain in the upper left quadrant of the abdomen six days ago. The pain started after the patient ate, and it gradually worsened. He had not suffered any chronic disease except hypertension for three years and without reasonable and effective therapy. He reported no fever, nausea, vomiting , rectal bleeding, melena, or dysuria, and no history of iatrogenic injury from instrumenta-tion or trauma. At presentation, his blood pressure was 158/85 mmHg at both arms. The physical examination was normal. Initial blood tests including cardiac enzymes, complete blood count, renal function tests, liver enzymes, amy-lase, lipase, and d-dimer were in normal ranges. Serial ECG's were all normal sinus rhythm. The computer tomography angiography (CTA) scan showed an aorta dissection associated with retrograde formation of a giant descending thoracic aneurysm arising in suprarenal locations, and sparing both renal and mesen-teric vessels, without any branch vessel involvement or visceral damage (Figure 1). Digital subtraction angiography demonstrating a very clear view of isolated suprarenal aorta dissection, without abnormal of other artery branch and infrarenal abdominal aorta, and the ostia of tear is adjacent the celiac trunk (Figure 2). Hepatic and renal arteries blood flow as normal. Liver, spleen, bowel, and kidney perfusions were also normal. Conservative treatment including control heart rate and antihyperten-sive had been chosen for one week, but no relief for the abdominal pain of the patient. Because of the patient's persistent epigastric pain, surgery or aortic repair deserves consideration. However, to keeping the other arteries branch flow and reducing the high-risk, open surgery was less appropriate than endovascu-lar aortic repair. So the patient was taken to the hybrid operating room for endovascular aortic repair. The true lumen of the celiac artery was
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