CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2018; 02(03): S3
DOI: 10.1055/s-0041-1730653
Abstract

Acute Respiratory Insufficiency in Patients with Acute Type B Aortic Dissection: An Indication for Urgent Intervention

Mohammad Raffat Jaber
Harbor UCLA Medical Center, Los Angeles, US
› Author Affiliations

Background: In this series, we examine six patients whom presented with acute Stanford type B aortic dissection with malperfusion and associated acute pulmonary syndrome with pleural effusion and lung disease similar to adult respiratory distress syndrome. Current discussions encourage attempts to stabilize the patient for an interval of 7–14 days to enhance thoracic endovascular aortic repair (TEVAR) outcomes; however, pulmonary compromise signals the need for more urgent intervention. Methods: Case Series (reports of new indications for TEVAR). Results: All six patients otherwise have no known prior history of chronic lung disease. Two patients presented with lower extremity weakness. One patient presented with spinal ischemia and bilateral lower extremity weakness. The fourth patient presented with acute renal insufficiency. The fifth patient presented with chest and back pain, acute renal insufficiency, and lactic acidosis. One of the five patients required tube thoracostomy placement and intubation. The second patient responded well to noninvasive positive pressure, Bilevel Positive Airways Pressure airway ventilation (BIPAP), and diuresis. The third patient remained intubated until he expired 1-week postoperatively. The fourth patient developed acute pulmonary insufficiency before any operative interventions and died shortly after intubation. The fifth patient's respiratory status markedly improved after intervention. Four patients underwent uneventful TEVAR of their descending thoracic aortic dissections. Conclusion: Current discussions encourage attempts to stabilize the patient for an interval of 7–14 days to enhance TEVAR outcomes; however, pulmonary compromise signals the need for more urgent intervention.



Publication History

Article published online:
11 May 2021

© 2018. The Arab Journal of Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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