Causes and treatment of intimo-intimal intussusception in endovascular repair of aortic dissecting aneurysms

Objective Todiscuss the causes and treatment of intimo-intimal intussusception in endovascular repair of aortic dissecting aneurysms. Methods This retrospective study included 7 patients with intimo-intimal intussusception who underwent endovascular repair of aortic dissecting aneurysms from January 2017 to June 2018. There were 5 males and 2 females aged 34 to 64 years (mean 47.1 years), with a clinical course from 8 hours to 3 months. Six cases presented with acute chest pain and 1 had abdominal pain. Preoperative CTA was performed in all patients to confirm the diagnosis. Six patients received thoracic endovascular aortic repair (TEVAR) and 1 receivedfenestration. Results The endovascular repairs were successful without converting to open surgery in all patients. Pathological classifications were 1 type Ⅰ, 5 type Ⅱ and 1 type Ⅲ. Four patients received another aortic stent at distal segment to cover the intimo-intimal intussusception and 1 patient at proximal site. One patients received another bare stent in the superior mesenteric artery, and 1 case received abdominal aortic stent implantation. Balloon was used in 2 cases to dilate the stenosis of aortic stents. The death occurred in 1 case at 3 days after surgery for metadata object description schema, and 1 patient needed continuous renal dialysis after discharge. The postoperative conditions (from 7 to 21 days) of other patients were normal without paraplegia, bowel necrosis, lower limb ischemia or arterial rupture. Conclusions The results indicate that the intimo-intimal intussusception in endovascular aortic dissecting aneurysms repair is rare and it is a severe complication. Re-endovascular aortic repair is a safe and reliable surgical approachbased on the type in early phase. Key words: Aortic dissection; Endovascular repair; Arterial intima; Intussusception