Repeated true lumen collapse after repair of descending thoracic aneurysm in chronic type B dissection.

The patient was 69-year-old man. Dilatation of the descending thoracic aorta in chronic type B dissection was revealed on computed tomography. During replacement of the descending thoracic aorta, distal anastomosis was performed in a double-barreled manner. On postoperative day (POD) 3, the patient complained of paralysis and dysesthesia of both legs, and he developed acute renal dysfunction. Based on the results of emergent aortography, we suspected true lumen collapse resulting from an expanded false lumen; therefore, we stabilized the intimal flap to the aortic wall. However, on POD 7 he complained of coldness in both legs. Emergent aortography revealed that occlusion of the abdominal aorta had recurred, and so right axillobifemoral bypass was performed. Preoperative conventional angiography may be mandatory to confirm reentry. There have been several reports of transcatheter fenestration in acute or chronic aortic dissection. The technique would also be effective for postoperative malperfusion.