Thoracic Endovascular Aortic Repair (TEVAR) Coincide with

Percutaneous Transluminal Angioplasty (PTA) as Management of

Acute Type B Aortic Dissection with Malperfusion Syndrome : A
Complicated Vascular Intervention
A.I.S Putra1, B.A.P.D Sutanegara1, A.P. Suwirya1, Taofan2

1Faculty of Medicine Udayana University/Prof. dr Ngoerah Hospital, Denpasar, Indonesia

2Faculty of Medicine University of Indonesia/National Cardiovascular Centre Harapan Kita Hospital, Jakarta, Indonesia

1 Background
Type B aortic dissection complicated to malperfusion syndrome, causing blood flow obstruction of the vascular branches
can be life-threatening if not treated properly. Thoracic Endovascular Aortic Repair (TEVAR) coincide with Percutaneous
Transluminal Angioplasty (PTA) as additional interventional modalities can be useful for treating such complication.

2 Case Illustration
A 42-year-old male came with pain in the left lower
leg since 1 hour accompanied with chest discomfort

The left lower extremity was paler, cold, and had no

pulse from proximal to distal arteries with illegible
saturation.

Doppler ultrasonography of left extremity revealed

thrombus in the left iliac to left femoral artery without
colour flows. A B

CT Angiography with contrast revealed intimal flap

with the entry point in the descending aorta at the
level of the Th3 CV and the exit point in the left
common iliac artery, accompanied by the presence of
intraluminal thrombus.

Despite early management and heparinization, TEVAR

procedure was done with Thoracic Stent Graft 34 mm
x 130 mm, implanted right after accessory left
vertebral artery.

Due to negative flow of the left common iliac artery,

PTA was conducted with extending stent distally and
overlapping between stents. C D

Observation post procedure showed excellent result

with a significant clinical improvement, normal Figure: A. CTA Thoracoabdominal B. Aortic stent implantation and aortography C. PTA at
saturation, good blood flow according to USG left common iliac artery to femoral artery D. USG doppler evaluation post procedure with
doppler and CT scan evaluation. good blood flow

6 Conclusion
This case demonstrated type B acute aortic dissection with complication of malperfusion syndrome using TEVAR and PTA
procedure as vascular interventions. Despite challenging interventions, comprehensive diagnostic modalities and good
procedural management skill showed excellent result in this patients’ population.