Key result
Emergent open repair with partial endograft explantation in a 65-year-old man with de novo type B dissection 7 years post-EVAR achieved reconstruction but ended in postoperative death.
Why the study?
Although EVAR requires lifelong surveillance for late aortic and device-related complications, the occurrence of a de novo antegrade Stanford type B aortic dissection after EVAR is poorly characterized.
Case Report (n=1)
This case highlights that rare, catastrophic de novo antegrade Stanford type B aortic dissection with graft thrombosis can occur late after EVAR, underscoring the necessity of lifelong surveillance and rapid multidisciplinary management.
Answers are grounded in this paper and cite their sources.
Alerts clinicians to rare late type B dissection post-EVAR; leaves open incidence, predictors, and surveillance needs.
Endovascular aneurysm repair (EVAR) reduces early perioperative morbidity but requires lifelong surveillance due to late aortic and device-related complications. The occurrence of a de novo antegrade Stanford type B aortic dissection after EVAR is poorly characterized. We report the case of a 65-year-old man with prior aorto-biiliac EVAR who presented seven years later with sudden severe abdominal and lumbar pain followed by acute left lower-limb paralysis. Emergency Computed Tomography Angiography (CTA) revealed an acute antegrade Stanford type B dissection originating distal to the left subclavian artery (LSA), true-lumen occlusion along the endograft with graft thrombosis but extensive false-lumen perfusion with impending rupture. Emergent open repair was undertaken with partial endograft explantation. Despite successful technical reconstruction, the patient developed cardiocirculatory complications and died during postoperative period. This case documents a rare, catastrophic de novo antegrade type B dissection after EVAR. The report underscores the need for heightened vigilance in long-term surveillance, consideration of dissection in differential diagnosis of late EVAR complications, and the importance of rapid multidisciplinary decision-making.
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Borghese et al. (2026) conducted a case report in De novo antegrade Stanford type B aortic dissection with graft thrombosis and visceral malperfusion after EVAR (n=1). Emergent open repair with partial endograft explantation was evaluated on Postoperative survival and technical reconstruction. Emergent open repair with partial endograft explantation in a 65-year-old man with de novo type B dissection 7 years post-EVAR achieved reconstruction but ended in postoperative death.
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