SIRRFS

Radiology

Answers:

1. Wide-open aortic regurgitation
2. Anti-hypertensive medication

The patient was administered Esmolol and Nicardipine. IR consulted and recommended dissection flap fenestration and true lumen aortic and branch-vessel stenting.

Bilateral femoral access was obtained. Intravascular ultrasound (IVUS) revealed thrombus in the bilateral common femoral, external iliac, and common iliac arteries. Mechanical thrombectomy performed.

Figure 1.

Using IVUS, the needle and cannula were advanced into the abdominal aorta. A puncture was made in the intimal flap between the true and false lumens. A wire was advanced through the puncture into the false lumen and fenestration dilated with a balloon.

Figure 2.

A self-expanding stent deployed into the aorta with caudal end lying just above SMA origin.

Figure 3.

Self-expanding stents deployed in the infrarenal abdominal aorta. Bilateral kissing iliac stents placed with external iliac extensions.

Post-procedure patient underwent successful aortic repair, bilateral femoral cutdowns with SFA thromboembolectomy, patch angioplasty, and bilateral 4-compartment fasciotomies. Patient discharged on day 28 to rehab.

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