International Society For Minimally Invasive Cardiothoracic Surgery

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Paraplegia Resolution After Implantation Of A Percutaneous Stent Graft In Intramural Hematoma and Type B Aortic Dissection
Mariano García-Borbolla1, Rafael García-Borbolla1, Bella Ramírez1, Mariano García-Borbolla Balboa2.
1Hospital Virgen Macarena, Sevilla, Spain, 2Universidad de Alcalá de Henares, Madrid, Spain.

OBJECTIVE: Intramural hematoma and type B aortic dissection are some entities that are treated conservatively if there are no complications. We report a case of a patient who presented paraplegia at 24 hours of evolution and was resolved satisfactorily after implantation of stent graft and drainage of cerebrospinal fluid.METHODS: A 70-year-old went to the emergency room presented with chest and abdominal pain, irradiated to lower limbs. Computed tomography with contrast was performed, and the man was diagnosed with hematoma intramural and type B dissection. The patient presented an aortic intramural hematoma that continued with aortic dissection 9 centimeters above the ostium of the celiac trunk and extended to the left femoral artery. The patient was admitted to the critical care unit, presenting at 24 hours paraplegia and increased pain despite blood pressure control. Lumbar puncture and drainage of cerebrospinal fluid was performed, maintaining a pressure not exceeding 10 millimeters of mercury. Subsequently, a percutaneous stent graft was placed through the right femoral artery from the left subclavian artery with prolongation to the celiac trunk. the access of the femoral artery was closed with a percutaneous closure system. RESULTS: After the intervention, the patient went to the postoperative care unit, where he continued with the drainage of cerebrospinal fluid for 72 hours, progressively recovering mobility, and the pain and symptoms disappeared. A computerized tomography control was performed after a few days, showing a decrease in the intramural hematoma and persistence of the distal dissection image.The patient was discharged 7 days after the intervention walking properly, and remains asymptomatic after more than 1 year of follow-up. CONCLUSIONS: It is an intramural hematoma with accompanying type B aortic dissection that evolves poorly initially, presenting paraplegia and increased pain despite correct medical treatment.The dissection initially only progresses to the left femoral artery, allowing endovascular treatment by puncture of the contralateral artery.The treatment of the case allows the solution of the paraplegia and the patient evolves satisfactorily.LEGEND: On the left, image of the intramural hematoma and type B dissection On the right, after graft stent implantation

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