Endovascular Management of an Acute, Complex Aortic Dissection Resulting in Lower Extremity Ischemia with Aortic Septotomy Followed by EVAR

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Acute aortic dissections are associated with significant morbidity and mortality despite advances in diagnostic and therapeutic strategies. Type A dissections typically require emergency surgery, whereas intervention for type B dissections is currently only recommended for those with high-risk features associated with malperfusion, uncontrolled hypertension, rapid expansion, or rupture. The emergence of thoracic endovascular aortic repair has significantly altered the treatment paradigm by providing a less invasive alternative to open repair. More recent endovascular advancements have further expanded therapeutic options for high-risk patients and particularly those previously considered as non-operative candidates. This case report highlights the use of an advanced technique via aortic septotomy to rescue an acute lower extremity limb ischemia in an extremely high-risk surgery patient.

Patient is a 36-year-old male who presented with chest pain and left lower-extremity ischemia. Evaluation revealed a type A aortic dissection extending to the left external iliac artery. He underwent emergent repair of the type A dissection with the cardiothoracic surgery team and placed on central VA ECMO due to severe biventricular failure. A left lower-extremity distal perfusion catheter (DPC) was subsequently placed to temporize the left lower extremity ischemia, which was later disconnected after transitioning to right ventricular assist device (RVAD) support with an Impella device. Given ongoing instability, a definite repair to reperfuse his left leg was deferred and a right femoral DPC was placed to provide flow to the left leg. However, inadequate flow volumes led to progression of limb ischemia and the decision was made to pursue surgical repair after multidisciplinary discussion despite ongoing clinical instability.

This case highlights the complexity of aortic dissection management, which requires not only a multidisciplinary approach but also careful, patient-specific consideration when selecting surgical strategies, whether open or endovascular. It further underscores the critical importance of ongoing research and innovation to advance endovascular technologies for the treatment of complex, high-risk patients, with the goal of minimizing morbidity and mortality and optimizing patient clinical outcomes.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1990

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