Type

A Aortic Dissection Complicated with Refractory

Hypertension after Surgical Repair
Resident(s): Travis Howard, MD
Attending(s): Sanjay Misra, MD, Haraldur
Bjarnason, MD, and Reza Rajebi, MD
Program/Dept(s): Vascular and Interventional
Radiology

CHIEF COMPLAINT & HPI

Chief Complaint and/or reason for consultation

Complaints of recurrent dizziness at follow up appointments

History of Present Illness

Fifty-six year old man with history of Type A Aortic Dissection. He is one month removed from
ascending aortic and hemi-arch replacement with re-suspension of the aortic valve.

RELEVANT HISTORY
Past Medical History

Hyperlipidemia, Hypertension, DM II, CAD s/p stent placement, Obesity

Past Surgical History

Stanford type A aortic dissection repair Nov. 13, 2014

Family & Social History

Family history non-contributory

40 pack/year tobacco use history. Quit in 2007.

Review of Systems

Other than dizziness, review of systems was negative

Medications

ASA, Clopidogrel, Statin, Hydralazine, Labetalol, Amlodipine, Isosorbide mononitrate,

Nitroglycerin

Allergies
NKA

DIAGNOSTIC WORKUP
Physical Exam

Systolic blood pressures were elevated at 180-200mmHg. Otherwise, unremarkable.

Laboratory Data

Normal renal function

No electrolyte abnormalities

Non-Invasive Imaging

DIAGNOSTIC WORKUP: NON-INVASIVE IMAGING

Collage of images from a
CAP CT angiogram
demonstrates that the aortic
dissection flap extends into
the aortic arch. At the level
of the renal arteries, the right
renal artery is supplied by the
compressed true lumen. The
left renal artery is supplied by
the false lumen.

DIAGNOSTIC WORKUP: NON-INVASIVE

IMAGING
Doppler ultrasound at the origin of the right renal artery
demonstrates severely diminished renal artery velocity
and a tardus parvus waveform.

Doppler ultrasound at the level of the segmental right

renal arteries demonstrates significantly dampened
waveforms.

DIAGNOSTIC WORKUP: NON-INVASIVE

IMAGING
Doppler evaluation of the left
renal artery demonstrates
velocities at the upper end of
normal.

DIAGNOSIS
Hemodynamically significant stenosis of the right renal artery by the aortic
dissection flap

INTERVENTION

Right renal artery

Contrast filling the

true lumen

DSA: Catheterization of
the true lumen with
contrast filling the right
renal artery.

Mean arterial blood

pressure within the true
lumen measures
20mmHg.

Link to Video

INTERVENTION
DSA:
Catheterization of
the false lumen
with contrast
filling the left
renal artery.

Arterial blood
pressure within
the false lumen
measures 95
mmHg.

Link to Video

INTERVENTION

Pioneer Device

A Pioneer device was

advanced from the right
common femoral artery and
deployed towards the aortic
dissection flap into the false
lumen.