Chronic Abdominal Aortic Dissection with Large Aneurysm Unsuitable for Endovascular Treatment

A 70 year-old male sustained an AAD 8 years previously and was being monitored for an enlarging abdominal aortic aneurysm (AAA). A computed tomography (CT) scan confirmed an 8cm diameter AAA extending 9cm above the origin of the coeliac axis (CA). At the level of renal arteries (RAs) there was a dissection flap pressurising the false lumen. Both the RAs arose from the true lumen as did the superior mesenteric artery (SMA) with the dissection flap continuing into the left common iliac artery and then re-entering the true lumen at the origin of the left external iliac artery. The right iliac artery was unaffected. There were two further fenestrations along the length of the dissection flap pressurising the false lumen. As well as the primary tear at the level of both RA (Figure 1), a second tear 15mm distal to this and the last a further 65mm inferiorly (Figure 2). The inferior mesenteric artery (IMA) was occluded at its origin.