From Paralysis to Recovery: Hyperacute Type B Aortic Dissection Causing Complete Aortic Occlusion with Limb and Spinal Cord Ischemia

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

This case illustrates a rare, catastrophic hyperacute type B aortic dissection with complete aortoiliac malperfusion, bilateral limb ischemia, and spinal cord ischemia. Standard care would often involve extra-anatomic bypass with acceptance of paralysis, as TEVAR is high-risk in complete occlusion. In this young patient, an aggressive strategy-including multilevel TEVAR, open thrombectomy, prophylactic fasciotomies, and early lumbar drain-was pursued, reversing paralysis and achieving limb salvage. This highlights the value of individualized, physiology-driven management in complex aortic emergencies.

A 37-year-old woman with no significant medical history was found down in her apartment after a night out, reporting bilateral leg weakness and inability to walk. She awoke the next morning on the floor, missing personal belongings, with worsening leg weakness, prompting EMS activation. On presentation to an outside hospital, she had absent bilateral lower extremity pulses, cool ashen limbs, and profound motor deficits. CTA of the chest, abdomen, and pelvis revealed a hyperacute Stanford type B aortic dissection from the proximal descending thoracic aorta through the visceral segment, with near-complete true lumen collapse and complete infrarenal aortic occlusion causing bilateral limb ischemia. She was transferred urgently to a tertiary center for emergent management.

This case shows that even with complete aortic occlusion causing spinal cord and bilateral limb ischemia-usually managed with bypass and accepted paralysis-an aggressive, physiology-driven endovascular approach can be effective. Early restoration of true lumen flow combined with spinal cord rescue reversed paralysis and salvaged limbs, highlighting the value of individualized decision-making in young patients with potentially reversible ischemia.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1872

This document is currently not available here.

Share

COinS