Tomoko KUDO¹, Satoshi YUDA², Shoko YAMAGUCHI¹, Yuji OHMURA¹, Kosuke UJIHIRA³, Shunsuke SASAKI², Ryushi MARUYAMA³, Yoshihiko KURIMOTO³, Akira YAMADA³, Mitsugu HIROKAMI²

¹Division of Clinical Laboratory Medicine, Teine Keijinkai Hospital, ²Department of Cardiology, Teine Keijinkai Hospital, ³Department of Cardiovascular Surgery, Teine Keijinkai Hospital

キーワード : aortic dissection, two-dimensional transthoracic echocardiography, paravertebral approach, thoracic endovascular aortic repair, endoleak

We report a case of chronic type B aortic dissection in a 70-year-old man. At an outpatient hospital, he was found to have an expanded dissecting descending aortic aneurysm and was transferred to our hospital for thoracic endovascular aortic repair (TEVAR). A stent graft was successfully placed in the proximal descending thoracic aorta (DTA) to close the primary entry. Postoperative computed tomography (CT) revealed persistent contrast enhancement of the false lumen in the DTA that was suggestive of an endoleak. However, the origin and flow direction of the endoleak were uncertain, and classification of the endoleak was difficult. Hence, the echocardiographic paravertebral approach (PVA) was performed. Both the true lumen and false lumen were clearly visualized and retrograde flow from the intercostal artery into the false lumen was demonstrated by color Doppler examination. These findings suggested that the endoleak originated from the intercostal artery (type II) rather than the proximal end of the stent graft (type Ia). Hence, it was concluded that the patient should be observed conservatively. Follow-up CT at 8 months post-TEVAR showed no expansion of the maximal diameter of the DTA. In this case, the utility of PVA for detection and classification of an endoleak after TEVAR was confirmed.