Successful thoracic endovascular aortic repair for complicated Stanford type B acute aortic dissection with acute renal failure and vascular remodelling after intervention: case report and 5-year follow-up.

Background: Surgical treatment such as grafting or thoracic endovascular aortic repair (TEVAR) is recommended for Stanford type B acute aortic dissection (SB-AAD) with complications. We report a case of SB-AAD with acute renal failure caused by malperfusion that was successfully treated with TEVAR. Case summary: A 69-year-old man was diagnosed with SB-AAD at another hospital. Because he experienced worsening renal function, the patient was referred to our hospital. Enhanced computed tomographic angiography (CTA) revealed an entry point at the distal aortic arch and re-dissection that extended to the level of the bilateral iliac arteries. The entry site was approximately 20 mm distal to the origin of the subclavian artery on the greater curvature side. Because this false lumen compressed both renal arteries, we suspected renal ischaemia as the cause of acute renal failure and oliguria. We performed urgent TEVAR with left subclavian artery occlusion to improve renal ischaemia and function. Thereafter, urine output increased and renal function improved. Follow-up CTA performed 1 week postoperatively showed no enlargement of the dissection cavity or leakage. Favourable vascular remodelling was observed during 5-year follow-up. Discussion: Thoracic endovascular aortic repair performed in the early phase of SB-AAD may result in a satisfactory clinical course and vascular remodelling. However, careful consideration of its timing is required.