Case Study: Management of Thoracic Endovascular Aneurysm Repair (TEVAR) in an 82-Year-Old Male with Type B Aortic Dissection

Nandhini

Charge Nurse, Level 4 B, Kauvery Hospital, Alwarpet, Chennai

Abstract:

This case study presents an 82-year-old male patient who underwent successful TEVAR for Type B aortic dissection. The patient had a complex presentation with thoraco-lumbar spine fracture, aortic aneurysmal dilation, and compression fracture. The case highlights the importance of multidisciplinary management and timely intervention in patients with acute aortic dissection.

Introduction:

Thoracic Endovascular Aneurysm Repair (TEVAR) has emerged as a viable treatment option for patients with thoracic aortic aneurysms and dissections. This case study presents an 82-year-old male patient who underwent successful TEVAR for Type B aortic dissection.

Case Presentation:

An 82-year-old male patient presented with sudden onset severe upper back pain, sweating, and a history of fall. He was evaluated and diagnosed with Type B aortic dissection, thoraco-lumbar spine fracture, and aortic aneurysmal dilation.

Diagnosis:

– Type B aortic dissection

– Thoraco-lumbar spine fracture

– Aortic aneurysmal dilation

– Compression fracture (D11, D12, L1, and L2)

Clinical Symptoms:

– Sudden onset of severe upper back pain

– Sweating

History

– Chronic back pain

Treatment Done:

– TEVAR on 09.04.2025

– Deployment of Valiant Captivia 34-34-200 stent graft

– Fenestration made 1cm proximal to the end of the graft

– Bilateral longitudinal incision made over the groin

– Cannulation of right CFA and left SFA

– Angiogram showed bovine arch with innominate and left carotid artery

Home Care Instructions:

– Continue medications as prescribed

– Monitor blood pressure and blood sugar levels regularly

– Follow a healthy diet and exercise regimen

– Schedule follow-up appointments with the cardiologist and primary care physician

– Avoid heavy lifting and bending

Patient Attender Feedback:

The patient’s family expressed satisfaction with the care provided and thanked the healthcare team for their support and treatment.

Education to Patient:

– Importance of adhering to medication regimens

– Monitoring blood pressure and blood sugar levels

– Maintaining a healthy lifestyle

– Recognizing signs and symptoms of complications

Nursing Diagnosis:

– Acute pain related to thoraco-lumbar spine fracture

– Anxiety related to diagnosis and treatment

– Knowledge deficit related to disease management and treatment

Conclusion:

This case study highlights the importance of timely intervention and multidisciplinary management in patients with acute aortic dissection. The patient’s successful recovery is attributed to the collaborative efforts of the healthcare team, including cardiologists, nurses, and other support staff.

Recommendations:

– Healthcare providers should be aware of the characteristic symptoms and diagnostic findings of Type B aortic dissection.

– Patients presenting with Type B aortic dissection should undergo immediate TEVAR and be managed in a multidisciplinary setting.

– Close monitoring and follow-up are crucial for optimal patient outcomes.

Evidences

MRI Report

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