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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 6, November/December 2015
e12
AFRICA
Hornick
et al.
retrospectively analysed a series of AD cases
and they concluded that bovine arch anatomy is not associated
with increased incidence of AD compared with the normal
anatomical configuration. Therefore bovine arch anatomy was
likely not a significant factor in the development of AD in the
present case.
6
The primary treatment strategy for type A AD is graft
replacement of the ascending aorta.
5,7
However, dissection or
distension of the distal aorta may be neglected in most cases. In
the present case, the patient had undergone replacement of the
ascending aorta due to type A dissection nine months earlier.
Upon presentation, contrast-enhanced computed tomography
(CT) detected a progression of the previous flap to the level of
the renal artery. No additional progression of the dissection
flap had been observed in the previous CT images (Fig. 3). In
the earlier CT examination, the true lumen had retained the
contrast. However, our examination nine months later showed
the contrast agent passing through the false lumen.
Despite the absence of a rupture in the aorta, these recent flap
changes could have caused organ ischaemia due to the narrowing
of the lumen diameter. Therefore, we proposed that the type B
dissection was closely related to the previous type A dissection
in this case. Moreover, the same risk factors that resulted in the
previous dissection of the ascending aorta (hypertension, etc)
could also have resulted in disruption of the distal section of the
aortic intima, even though the damage to the proximal aorta had
been completely repaired.
Conclusion
TEVDAR application is beneficial to most patients diagnosed
with type B AD. Although this procedure is associated with
higher costs, the benefits of this intervention include reduced risk
of complications, shorter recovery time in the intensive care unit
and a more rapid return to normal quality of life. Additionally,
the management of type A AD using surgical and medical
hybrid therapy may be critical to the prevention of secondary
complications, such as the development of a secondary type B
AD. In high-risk AD cases, TEVDAR may result in improved
outcomes and a better quality of life.
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