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

Document Type

Conference Proceeding

Publication Date

10-2026

Publication Title

Journal of Vascular Surgery

Abstract

Objective: Acute type B aortic dissection with dynamic true lumen collapse causing infrarenal aortic occlusion and bilateral lower extremity ischemia is a rare and life-threatening presentation. Optimal management strategies for simultaneous proximal dissection and distal aortic occlusion remain poorly defined. We present a case of successful endovascular-first salvage with adjunctive open intervention.

Methods: A 37-year-old woman presented with acute bilateral lower extremity paralysis and absent pedal signals after being found down. Computed tomography angiography demonstrated a hyperacute type B aortic dissection extending from zone 3 to the infrarenal aorta with near-complete true lumen collapse and occlusion of the infrarenal aorta. The common femoral arteries reconstituted via epigastric collaterals. Given profound malperfusion, the patient was taken emergently for thoracic endovascular aortic repair with planned adjunctive lower extremity revascularization.

Results: Initial laboratory evaluation demonstrated severe ischemia with a creatine kinase level of 18,550 U/L. Bilateral femoral cutdowns were performed for access and distal embolic protection. Intravascular ultrasound confirmed true lumen access throughout the thoracoabdominal aorta. Multilevel thoracic endovascular aortic repair was performed to restore true lumen flow from zone 3 to the paravisceral segment, resulting in reperfusion of the visceral vessels. Persistent infrarenal aortic occlusion was treated with endovascular aortoaortic reconstruction using a covered stent, restoring inline flow to the iliac arteries. Residual thrombus in the right iliac system required open thrombectomy. Given prolonged ischemia, bilateral four-compartment fasciotomies were performed. Completion angiography demonstrated patent visceral vessels and restoration of lower extremity perfusion with return of distal signals. Postoperatively, significant bilateral lower extremity weakness raised concern for spinal cord ischemia, prompting immediate lumbar drain placement and hemodynamic optimization.

Conclusions: Neurologic function improved over several days with complete resolution of paralysis. At 6 months, the patient was fully ambulatory with palpable pedal pulses and no residual deficits, demonstrating successful limb salvage. Acute aortic occlusion due to type B dissection represents a severe form of malperfusion requiring rapid restoration of inline flow. An endovascular-first strategy to expand the true lumen, combined with targeted distal revascularization and aggressive spinal cord ischemia management, can result in excellent functional recovery in this high-risk population.

Volume

84

Issue

4

First Page

e368

Last Page

e368

Comments

Midwestern Vascular Society Annual Meeting, September 17-19, 2026, Chicago, IL

DOI

10.1016/j.jvs.2026.06.134

ISSN

0741-5214

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