59-year-old male patient with hypertension, smoking and dyslipidemia.
She began with chest pain retrofitting, oppressive, irradiating to both hypochondria and back, so she went to the emergency service five hours after the onset of symptoms.
On physical examination, the patient was alert, with blood pressure of 140/90, heart rate of 80 beats/min, with symmetrical and normal distal pulses, with no other relevant findings.
An electrocardiogram performed on the patient showed only left ventricular hypertrophy.
The radiograph showed no relevant findings.
Due to the persistence of severe chest pain and to rule out aortic dissection, an angiography was requested by computed axial tomography of the thorax and abdomen (Angio-Tac), which showed a flap of dissection of the descending aorta hemopericardium to a third extended level.
A type B acute aortic dissection complicated by rupture was diagnosed.
Due to the complication of dissection, favorable anatomy of the lesion and vascular accesses, endovascular stent grafting was decided.
The procedure was performed under general anesthesia, with access through femoral arteries and controlled hypotension, installing an endovascular stent graft (Talent®) of 34 mm in diameter and 130 mm technical site proximal fracture with immediate result coverage thoracic aorta.
In a control study, an adequate endoprosthesis position was found, excluding the false lumen of the thoracic aorta, with only the distal aorta originating from the inferior mesenteric artery permeability, which had not increased with respect to the entrance examination.
Vascular accesses showed no complications.
The patient was discharged five days after the procedure in good condition.
At follow-up one year after the procedure, the patient was in good general condition, with Angio-Tac that showed no complications in the stent, with total exclusion of the false thoracic lumen and no variations regarding the examination.
