Enhanced visual clarity of intimal tear using real-time 3D transesophageal echocardiography during TEVAR of a type B dissection

摘要

A relatively new technological advancement to enhance visual clarity during thoracic endovascular aortic repair (TEVAR) is demonstrated in a 76-year-old man being treated for a type B dissection (Figure, A,B). While surgical access to the left common femoral artery was obtained, a real-time 3-dimension-al transesophageal echocardiogram (RT 3D TEE) was used to evaluate the entire thoracic aorta (model iE33; Phillips Healthcare, And-over, MA, USA). The RT 3D TEE (Figure, C) revealed a dissection within the descending thoracic aorta not seen on preoperative computed tomographic angiography (CTA). An intraoperative aortogram (Figure, D) showed an aneurysm ~10 cm below the origin the left subclavian artery, with no filling defect. During intravascular ultrasound (IVUS) measurement for stent selection (Figure, E), a partially thrombosed localized dissection was incidentally discovered, which corresponded with the RT 3D TEE. At the completion of the procedure, the RT 3D TEE confirmed stent-graft exclusion of the aneurysmal segment and the intimal tear with no endoleak.