Case Report: staged segment-specific open and endovascular treatment of chronic post-dissection aortic disease with descending thoracic and giant infrarenal aneurysmal components
- 1Center of Interventional Radiology, National Research Oncology Center, Astana, Kazakhstan
- 2Center of Vascular and Reconstructive Surgery, National Research Oncology Center, Astana, Kazakhstan
- 3Doctoral School, Karaganda Medical University, Karaganda, Kazakhstan
Abstract
Background: Contemporary management of chronic post-dissection aortic disease includes open repair, thoracic endovascular aortic repair (TEVAR) with or without adjunctive false-lumen occlusion, fenestrated/branched endovascular repair, and staged open-endovascular strategies. Selection depends on anatomy, rupture risk, malperfusion, physiological reserve, and device availability.
Case presentation: A 56-year-old woman with body mass index 47.2 kg/m2 and major cardiometabolic comorbidity presented with progressive abdominal pulsation. CTA demonstrated chronic Stanford type B/DeBakey III dissection with descending thoracic aneurysmal degeneration to 52.7 mm, a dominant symptomatic infrarenal aneurysmal component measuring approximately 11–12 cm, bilateral common iliac involvement, and residual paravisceral dissection without treatment-triggering enlargement or malperfusion. No Crawford extent was assigned because complete longitudinal centerline imaging was unavailable. Stage I comprised transperitoneal open aorto-bi-iliac reconstruction. After 118 days, elective morphology-driven zone 2 TEVAR was performed to cover the reported proximal entry region and reduce antegrade false-lumen inflow. Intentional left subclavian artery (LSA) coverage without prophylactic revascularization was followed by symptomatic subclavian steal requiring unplanned carotid-subclavian bypass.
Results: No perioperative death, stroke, spinal cord ischemia, bowel ischemia, myocardial infarction, acute kidney injury, graft thrombosis, prosthetic infection, or access complication occurred. At latest follow-up, the patient was asymptomatic and all reconstructions were patent.
Conclusion: This case illustrates competing priorities in segment-specific management of chronic post-dissection aortic disease. The unequivocal indication for urgent infrarenal repair contrasted with discretionary pre-emptive thoracic intervention below the conventional diameter threshold. The LSA-related complication emphasizes prophylactic LSA preservation/revascularization, spinal collateral planning, and lifelong surveillance of the untreated paravisceral segment after previous abdominal aortic reconstruction.
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BibTeX
@article{chinaliyev2026case,
title = {{Case Report: staged segment-specific open and endovascular treatment of chronic post-dissection aortic disease with descending thoracic and giant infrarenal aneurysmal components}},
author = {Azat Chinaliyev and Mukhammejan Orazbay and Gulinur Chinaliyeva and Didar Khassenov and Tokan Sultanaliyev and Irlan Sagandykov and Aktolkyn Daumen},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1925462},
url = {https://doi.org/10.3389/fcvm.2026.1925462},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Case Report: staged segment-specific open and endovascular treatment of chronic post-dissection aortic disease with descending thoracic and giant infrarenal aneurysmal components
AU - Azat Chinaliyev
AU - Mukhammejan Orazbay
AU - Gulinur Chinaliyeva
AU - Didar Khassenov
AU - Tokan Sultanaliyev
AU - Irlan Sagandykov
AU - Aktolkyn Daumen
PY - 2026
DA - 2026/10/12
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1925462
UR - https://doi.org/10.3389/fcvm.2026.1925462
AB - Background: Contemporary management of chronic post-dissection aortic disease includes open repair, thoracic endovascular aortic repair (TEVAR) with or without adjunctive false-lumen occlusion, fenestrated/branched endovascular repair, and staged open-endovascular strategies. Selection depends on anatomy, rupture risk, malperfusion, physiological reserve, and device availability. Case presentation: A 56-year-old woman with body mass index 47.2 kg/m2 and major cardiometabolic comorbidity presented with progressive abdominal pulsation. CTA demonstrated chronic Stanford type B/DeBakey III dissection with descending thoracic aneurysmal degeneration to 52.7 mm, a dominant symptomatic infrarenal aneurysmal component measuring approximately 11–12 cm, bilateral common iliac involvement, and residual paravisceral dissection without treatment-triggering enlargement or malperfusion. No Crawford extent was assigned because complete longitudinal centerline imaging was unavailable. Stage I comprised transperitoneal open aorto-bi-iliac reconstruction. After 118 days, elective morphology-driven zone 2 TEVAR was performed to cover the reported proximal entry region and reduce antegrade false-lumen inflow. Intentional left subclavian artery (LSA) coverage without prophylactic revascularization was followed by symptomatic subclavian steal requiring unplanned carotid-subclavian bypass. Results: No perioperative death, stroke, spinal cord ischemia, bowel ischemia, myocardial infarction, acute kidney injury, graft thrombosis, prosthetic infection, or access complication occurred. At latest follow-up, the patient was asymptomatic and all reconstructions were patent. Conclusion: This case illustrates competing priorities in segment-specific management of chronic post-dissection aortic disease. The unequivocal indication for urgent infrarenal repair contrasted with discretionary pre-emptive thoracic intervention below the conventional diameter threshold. The LSA-related complication emphasizes prophylactic LSA preservation/revascularization, spinal collateral planning, and lifelong surveillance of the untreated paravisceral segment after previous abdominal aortic reconstruction.
SN - 2297-055X
ER -