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Spontaneous Healing of an Acute Complicated Type B Aortic Dissection with Medical Therapy.
Naved U. Saqib, MD, Faryan Jalalabadi, BS, Kristofer Charlton-Ouw, MD, Anthony L. Estrera, MD, Hazim J. Safi, MD, Ali F. Azizzadeh, MD.
University of Texas Health Sciences Center at Houston, Houston, TX, USA.
OBJECTIVES:
Spontaneous healing (thrombosis and complete obliteration of the false lumen) in patients with acute complicated Type B aortic dissection (ACTBAD) is extremely rare. ACTBAD often requires endovascular or open surgical intervention. Thoracic endovascular aortic repair (TEVAR) has rapidly replaced open surgery as the less invasive option. We report a case of a spontaneous healing of ACTBAD in a patient who underwent an unsuccessful attempt at endovascular repair.
METHODS:
A 71-year-old man with hypertension and morbid obesity presented with acute back pain and lower extremity numbness. Computed tomographic angiography (CTA) revealed an acute type B aortic dissection with severe compression of the true lumen (Figure 1.A). Aggressive anti-impulse medical therapy was initiated. The patient developed worsening abdominal pain and acute renal failure despite medical therapy. He was taken to the operating room for intravascular ultrasound (IVUS) and intent to treat with TEVAR. Intraoperative IVUS revealed a thrombosed and severely compressed true lumen. Limited flow from the false lumen was visualized in celiac, superior mesenteric and renal arteries. TEVAR was aborted due to inability to cross the true lumen into the ascending thoracic aorta. Aggressive medical therapy was continued. He was discharged to a long term facility on hospital day 7. A follow up visit was scheduled in 4 weeks, 6 months and yearly thereafter.
RESULTS:
At the time of the follow-up visit, the patient was making satisfactory recovery. The 1 month follow-up CTA demonstrated spontaneous healing of the dissection, patent celiac, superior mesenteric, renal and iliac arteries, and no dissection flap was visualized (Figure 1.B). The 6 month, 1 year and 2 year follow-up CTA (Figure 1.C) demonstrated complete healing of the ACTBAD without aneurysmal degeneration.
CONCLUSIONS:
We report spontaneous healing and resolution of ACTBAD while on medical therapy, followed clinically and with serial imaging for 2 years. To our knowledge, this represents the first spontaneous healing of an ACTBAD reported in the literature.
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