Case Report on IVUS of Total Visceral Ischemia Guided Rescue After Endovascular Stent Grafting for Stanford Type B Aortic Dissection

Summary

This protocol describes IVUS-guided rescue of aortic intimal intussusception causing visceral ischemia after TEVAR in a Stanford Type B dissection.

Abstract

This case aims to report and analyze the diagnosis and management of total visceral ischemia caused by aortic intimal intussusception (AII) following thoracic endovascular aortic repair (TEVAR) in a patient with Stanford type B aortic dissection, and to explore the usage of intravascular ultrasound (IVUS) in precise rescue. A 47-year-old male with hypertension presented with acute chest and back pain. Computed tomography angiography (CTA) confirmed Stanford type B aortic dissection, and the patient underwent TEVAR. On postoperative day 3, the patient developed abdominal distension, hypoxemia, and severe deterioration of hepatic and renal function (ALT 4485 U/L, AST 4051 U/L, creatinine 259.3 µmol/L), indicating total visceral ischemia. To avoid contrast-induced nephropathy, IVUS was used in the reintervention to clearly diagnose severe distal true lumen compression caused by AII (true/false lumen ratio 6:1). Under IVUS guidance, two bare stents were successfully implanted, and tri-lobe balloon dilation was performed to restore true lumen patency. Post-intervention, visceral ischemia symptoms gradually resolved, and early follow-up CTA confirmed that all visceral arteries were perfused through the true lumen. At the 3-month follow-up, the patient's hepatic and renal function returned to normal (ALT 15 U/L, creatinine 86.1 µmol/L), and he had resumed daily activities. This case confirms the critical role of IVUS in reducing contrast use, accurately evaluating vascular anatomy, and guiding stent deployment, providing a practical reference for the diagnosis and management of complex complications after TEVAR.

Introduction

The primary objective of this case report is to demonstrate the value of intravascular ultrasound in the diagnosis and guided treatment of AII-induced total visceral ischemia following TEVAR for Stanford Type B aortic dissection, and to highlight its potential role in optimizing complex endovascular protocols. TEVAR has become the standard treatment for Stanford Type B aortic dissection, offering the advantages of minimal invasiveness and reduced perioperative morbidity compared with open surgery¹. However, rare complications such as AII can occur, leading to life-threatening visceral ischemia with high mortality if not promptly addressed

Protocol

​This project was approved by the Medical Technology Ethics Committee of Guilin Hospital of the Second Xiangya Hospital of Central South University. Written informed consent was obtained from the patient prior to the intervention, including permission for the use of clinical data and images for research purposes.

1. Pre-reintervention preparation

1. Clinical indication: True lumen collapse and visceral ischemia were suspected following initial TEVAR for Stanford Type B aortic dissection.
2. Imaging review: Prior CTA and intraoperative angiography were analyzed to identify residual false lumen flow and true lumen compre....

Results

AII represents a rare yet catastrophic complication of TEVAR. Postoperative surveillance for true lumen integrity, especially in high-risk patients, is paramount. IVUS-guided strategies offer a safe and effective approach for managing such cases, particularly in renal-compromised patients. Early imaging and tailored interventions significantly improve outcomes.

In this Case, IVUS-guided reintervention proved critical in restorin.......

Discussion

AII, characterized by circumferential intimal detachment and distal migration, remains a rare but life-threatening complication of TEVAR. Our case demonstrates that IVUS-guided intervention not only resolved true lumen collapse but also restored visceral perfusion while mitigating contrast-related risks in a renal-impaired patient. This aligns with emerging evidence highlighting IVUS's superiority in complex aortic pathologies^5,7. The pathogenesis of AII like.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Aortic Stent-graft	Lifetech	REF:TAA3024B200	The size and length of the stent?a proximal diameter of 30mm, a distal diameter of 20mm, and a length of 200mm
Bare Stents	Hangzhou Wei-Qiang Medical Technology Co	DM-TB-2828100;DM-TB-2626100	The size and length of the stent?DM-TB-2828100--a proximal diameter of 28mm, a distal diameter of 28mm, and a length of 100mm DM-TB-2626100--a proximal diameter of 26mm, a distal diameter of 26mm, and a length of 100mm
Tri-lobe Balloon	W.L.Gore&Associates,Inc.	BCL2645	-
Vision PV .035 Digital IVUS Catheter	Volcano corporation	REF:88901	-