Extensive aortic intimal intussusception during thoracic endovascular aortic repair for type B aortic dissection associated with aberrant right subclavian artery.

Aortic intimal intussusception during thoracic endovascular aortic repair is a rare but potentially catastrophic complication that can lead to severe distal malperfusion. We report a case of extensive aortic intimal degloving during thoracic endovascular aortic repair for acute type B aortic dissection in a 42-year-old woman with an aberrant right subclavian artery. Immediately after stent graft deployment, angiography demonstrated distal flow stagnation and a marked reduction in the lower extremity arterial pressure. Further imaging revealed distal migration of a detached intimal flap into the abdominal aorta with compromised visceral perfusion. Manipulation with a Coda balloon was used to relocate the intimal mass below the renal arteries, followed by endovascular reconstruction of the celiac artery, superior mesenteric artery, and bilateral renal arteries with additional aortic and iliac stenting. Balloon-assisted intimal relocation combined with multibranch endovascular reconstruction may provide an effective rescue strategy for this rare complication.