Transoesophageal Echocardiography-assisted Thoracic Endovascular Aneurysm Repair in a Case of Stanford Type B Aortic Dissection: An Adjunctive Imaging Modality

Aortic dissection is a life-threatening condition. A hypertensive lady presented with the complaints of sudden onset chest pain, with radiation to back. Initially managed with control of the hypertensive urgency, she was found to have Stanford type “B” aortic dissection, starting distal to the origin of the left subclavian artery with multiple entry points in the spiral aortic dissection flap whose distal extension was till the left renal artery. The descending aorta was 6.7 cm in diameter with thinned out aortic wall. She was offered emergency “Thoracic endovascular aneurysm repair” for exclusion of the thoracic segment and the false lumen. In view of the multiple entries in the spiral aortic dissection flap to negotiate the guidewire in the true lumen was an Herculean challenge. Transthoracic echocardiography was utilized in conjunction with fluoroscopy to successfully guide the procedure and ensure complete exclusion of the false lumen. Complimentary use of these two techniques is known in cardiology, but the same has not been mandated in the aortic diseases. Transthoracic ultrasonography delineates the aortic architecture and as in this case can play an important role in guiding wire cannulation of the true lumen in the presence of multiple flap entry points.