Ruptured Acute Type B Dissection Superimposed on the Abdominal Aortic Aneurysmal Wall Wrapping a Prior Graft

(a) Computed tomograph on admission at the distal arch level. This documents the absence of ulcer like projections (ULP). (b) Computed tomograph on admission at the carina level. Again, no ULP are present. (c) Computed tomograph on admission at the right renal artery level showing thrombo-occluded false lumen. (d) Computed tomograph on admission around the previous suture line showing a thin hematoma around a previously implanted graft for an infrarenal abdominal aortic aneurysm. There is evidence of retroperitoneal bleeding (H).

(a) Computed tomograph on day 6 at the distal arch level. Still no ULP. (b) Computed tomograph on day 6 at the carina level with no ULP. (c) Computed tomography on day 6 at the right renal artery level showing patent false lumen (PF). (d) Computed tomography on day 6 around the previous suture line showing the encased hematoma around the graft, part of which is enhanced by contrast medium (ES).

Intraoperative photograph indicating dissection of the aortic wall wrapping the graft and hematoma. A: the intima adheres to the graft, B: hematoma, C: the adventitia.

(a) Computed tomograph 4 months after operation at the distal arch level, now showing a small ULP. (b) Computed tomograph 4 months after operation at the carina level also showing a ULP. (c) Computed tomography 4 months after operation at the right renal artery level. Compared to Fig. 2-c, prior to surgery, this shows a smaller but still patent false lumen (PF). (d) Computed tomography 4 months after operation around the previous suture line showing neither anastomotic aneurysm nor retroperitoneal hematoma.