European heart journal. Case reports · 2025
Complete entry closure in isolated abdominal aortic dissection with a vascular plug: a case report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Hasegawa Shin, Hosoba Soh, Tanaka Akimitsu, Ohashi Takeki
Аннотация
BACKGROUND: Isolated abdominal aortic dissection (IAAD) is a rare vascular condition. Treatment options remain unclear due to the lack of established consensus on the most effective approach. While endovascular plugs have been successfully reported to seal the primary entry tear in thoracic aortic dissections, their utility in IAAD remains uncertain.
CASE SUMMARY: A 79-year-old woman presented with abdominal pain and was diagnosed with acute Stanford Type B aortic dissection, for which conservative blood pressure management was undertaken. A dissecting aneurysm in the infrarenal abdominal aorta and right common iliac artery (CIA) was identified. Follow-up computed tomography at 55 months revealed rapid aneurysmal expansion in the CIA. To prevent rupture, two intimal tears were sealed using an Amplatzer Vascular Plug II (AVP II; Abbott Laboratories, Chicago, IL, USA), resulting in complete elimination of contrast leakage into the false lumen and reduced aneurysm size in mid-term follow-up.
DISCUSSION: The use of the AVP in IAAD proved effective by promoting thrombosis within the false lumen and preventing its expansion. This offered a less invasive alternative, avoiding complications associated with endovascular aortic repair or open surgery, especially given the patient's challenging anatomy. However, potential risks such as exacerbation of the entry tear or embolic events should be considered, warranting careful deployment with an endovascular plug. Amplatzer Vascular Plug-based entry closure provides an effective, less invasive strategy for IAAD management. Further research is needed to confirm its long-term safety and efficacy.
CASE SUMMARY: A 79-year-old woman presented with abdominal pain and was diagnosed with acute Stanford Type B aortic dissection, for which conservative blood pressure management was undertaken. A dissecting aneurysm in the infrarenal abdominal aorta and right common iliac artery (CIA) was identified. Follow-up computed tomography at 55 months revealed rapid aneurysmal expansion in the CIA. To prevent rupture, two intimal tears were sealed using an Amplatzer Vascular Plug II (AVP II; Abbott Laboratories, Chicago, IL, USA), resulting in complete elimination of contrast leakage into the false lumen and reduced aneurysm size in mid-term follow-up.
DISCUSSION: The use of the AVP in IAAD proved effective by promoting thrombosis within the false lumen and preventing its expansion. This offered a less invasive alternative, avoiding complications associated with endovascular aortic repair or open surgery, especially given the patient's challenging anatomy. However, potential risks such as exacerbation of the entry tear or embolic events should be considered, warranting careful deployment with an endovascular plug. Amplatzer Vascular Plug-based entry closure provides an effective, less invasive strategy for IAAD management. Further research is needed to confirm its long-term safety and efficacy.