Coronary angiography in chronic aortic dissection

A 67-year-old man was followed up by the thoracic surgeons with annual computed tomography (CT) scans for a chronic type B dissection of his thoracic aorta. He had medically treated hypertension and was a smoker. On the CT scan the descending aorta measured 6.4 cm and elective surgical intervention was planned. The patient was well and relatively asymptomatic with normal renal function. All peripheral pulses were present. He was listed for a coronary angiogram preoperatively. The procedure was undertaken via the right femoral artery. Access was gained easily but it was not possible to advance the guide wire beyond the arch. An arch aortogram was undertaken (Figure 1) which confirmed that the guide wire was in the false lumen. The coronary arteries were intubated via the right brachial approach (Figure 2). It appears that coronary and upper limb perfusion was from the true lumen and the rest from the false lumen.