Thoracic endovascular aortic repair for acute type B aortic dissection complicated by total occlusion of the abdominal aorta.

A 72-year-old man presenting with lower body malperfusion and complete paralysis was transferred for emergency treatment of a complicated acute type B aortic dissection. Enhanced computed tomography showed occlusion of the true lumen inside the abdominal aorta due to compression of the false lumen, accompanied by a Crawford extension type IV thoraco-abdominal aortic aneurysm. The primary entry tear was located at the level of the tenth thoracic vertebra above the aneurysm. Emergency thoracic endovascular aortic repair was performed to cover the entry tear and to regain perfusion of the lower body. Efforts to perform retrograde insertion of a guidewire from the femoral arteries to pass the occluded abdominal aorta were unsuccessful. A through-and-through guidewire technique between the left brachial artery and the right femoral artery was performed to deliver a Zenith TX-2 stent graft from the right femoral artery. After closure of the primary entry tear, complete recovery from the occlusion of the abdominal aorta was obtained 6 h after the onset. His paralysis recovered completely, and the postoperative course was uneventful without reperfusion injury.