Iatrogenic type a aortic dissection: Conservative treatment after complicated left subclavian artery recanalization

摘要

Iatrogenic aortic dissections account for 5% of aortic dissections, with type A dissections being the most common (1). During thoracic endovascula-r aortic repair, retrograde type A dissections occur in 2% of procedures (1,2). The decision how to manage this potentially lethal complication can be difficult.We report a case of a 72-year-old woman with progressive claudication of her left arm and previous history of hypertension who was seen at our hospital's vascular outpatient clinic. She presented with pain in the left arm during exercise and numbness and cramping of her fingers. No vertigo or other symptoms of subclavian steal syndrome were present. Diagnostic computed tomo-graphic (CT) angiography showed an ostial occlusion of the left subclavian artery (LSA) 25 mm in length, whereas the other aortic arch branches were patent. There was an anatomic variant with the left vertebral artery (LVA) arising directly from the aorta, explaining the absence of subclavian steal symptoms. The patient was scheduled for endovascular recanalization of the LSA occlusion.