Cor Vasa 2017, 59(2):e163-e170 | DOI: 10.1016/j.crvasa.2016.04.006

Successful endovascular treatment of type B aortic dissection in a 15-year-old child

Ivo Petrov^a,*, Anna Kaneva-Nencheva^b, Elisaveta Levunlieva^b, Kamelia Genova^b, Iskren Garvanski^a, Georgi Konstantinov^c, Gloria Adam^d

^a Cardiology Department, "City Clinic" Sofia University Hospital, Bulgaria

^b Pediatric Cardiology Department, National Heart Hospital, Sofia, Bulgaria

^c Vascular Surgery, National Heart Hospital, Sofia, Bulgaria

^d Diagnostic Imaging Department, "City Clinic" Sofia University Hospital, Bulgaria

Aortic dissection is a rare condition in the pediatric and young adult population [1]. Here, we present an unusual case of a 15-year-old male patient with sudden onset of chest and back pain and numbness in the left leg. Chest and abdominal CT revealed Stanford type B (DeBakey type III) aortic dissection, leading to subocclusive stenosis of the superior mesenteric artery (causing critical intestinal dysfunction with ileus) and total occlusion of left iliac and left renal arteries. The child was admitted 48 hours after chest pain onset in critical clinical condition. Revascularization was achieved by several consecutive endovascular procedures, and the patient was discharged after favorable clinical evolution with full restoration of flow in the target organ arteries. The first interventional treatment included stenting of the superior mesenteric artery, stenting of the abdominal aorta, and balloon dilatation of the left iliac artery. Due to resistant renovascular hypertension, stenting of the left renal artery, which was occluded, was conducted 20 days later, leading to optimal blood pressure control. Thirty-three days following the initial procedure, an endovascular endograft prosthesis implantation was performed to close the primary tear in the thoracic aorta. Genetic samples revealed ACTA2 mutation. This case is extraordinary because of its combined life-threatening aortic and vessel pathology, treated for the first time with endovascular means in a child, and highlights the feasibility of endovascular treatment in the pediatric population. We discuss the imaging, management, and successful outcome of this severe condition.

Received: March 22, 2016; Accepted: April 17, 2016; Published: April 1, 2017  Show citation