Type B Thoracoabdominal Aortic Dissection (TBAD) with fusiform aneurysm of infra-renal abdominal aorta

Sripreethi^1*, Merin²

¹Nurse Educator, Kauvery Hospital, Heart city, Trichy, Tamil Nadu

²Ward Staff Nurse, Kauvery Hospital, Heart city, Trichy, Tamil Nadu

Abstract

Aortic dissection accompanied by abdominal aortic aneurysm is a rare and life-threatening vascular condition requiring multidisciplinary management. We report the case of 58 years old male presenting with severe back pain, dyspnea and hypertensive emergency, diagnosed with Stanford Type B thoracoabdominal aortic dissection associated aorta and partial thrombosis of the false lumen. The patient was managed medically with strict blood pressure control, anti-platelet, statins, hypoglycemic agents and supportive therapy serial imaging revealed no signs of impending rupture. His condition stabilized gradually, and he was discharged with strict lifestyle and medication advice. The case highlights the importance of early detections, hemodynamic stabilization and multi-disciplinary monitoring in complex aortic pathologies.

Introduction

Aortic dissection is catastrophic event resulting from a tear in the intimal layer of the aorta, creating a false lumen Stanford type B aortic dissection involves the descending thoracic aorta and complication may extend to the abdominal aorta.

Risk factors include

Hypertension
Dyslipidemia
Smoking
Male gender
Advanced age

This case presents a complex combination of type B aortic dissection, dilated thoracic and ascending aorta and fusiform infra-renal aneurysm, managed successfully with optimal medical therapy.

Case presentation

The patient presented with sudden onset severe back pain radiating to the chest, associated with dyspnea at admission, BP was markedly elevated, initial management stabilized his condition, and he was subsequently referred for vascular evaluation.

Investigation

ECG Report

CT Angiography (TA) Findings

Stanford Type B aortic dissection
Fusiform aneurysm of the infra-renal abdominal aorta
Partial thrombosis of false lumen.
Dissection involving descending thoracic aorta.

ECHO Cardiography Findings

Dilated ascending aorta (43mm).
Dissection flap in ascending aorta above aortic leaflet.
Dilated thoracic aorta.
Mild to moderate aortic regurgitation.

Clinical course in Hospital

The patient was admitted to the CCU for hemodynamic monitoring initial care included.

IV Antihypertensive
Pain management
Hypoglycemic control
Beta-Blockers to reduce shear stress in aortic wall.
Statins and anti-platelet therapy

He was evaluated by

Vascular surgery
Cardiology
Pulmonology
General surgery
Ophthalmology

With strict BP control and stabilizatrion progression of dissection was not seen in follow up scans.

Nursing Management

Monitor Vital Signs	• Continuous BP and ECG monitoring • Maintain BP < 120/80mmHg
Pain Control	• Give prescribed analgesics • Position comfortably (Semi – Fowler)
Administer Medications	• Beta-Blockers, anti-hypertensive, anti-platelets as per ordered. • Watch for side effects.
Prevent Rupture	• Bed rest, avoid straining coughing. • Give stool softeners.
Cardiac and Respiratory Monitoring	• Monitor heart sounds oxygen saturation. • Watch for chest pain breathlessness or signs of heart failure.
Reduce anxiety	• Explain condition and treatment. • Provide reassurance.

Condition at Discharge

Conscious, oriented, stable
BP: 130/80mmHg, PR: 80bpm
Abdomen soft, no tenderness
Cardiovascular and respiratory examination within normal limits.

Discharge Advice

Medications

Continue anti-hypertensive, statins, anti-platelets and diabetic medications as prescribed.

Diet

1500 Kcal/ day
Low fat, low salt, diabetic diet
Fluid intake 3 liters 1day

Lifestyle

Avoid strenuous activity.
No heavy lifting.
Prevent injury.
Smoking and alcohol cessation.
Regular follow ups with vascular surgery and cardiology.

Follow–up

Repeat CTA as advised.
Strict Bp monitoring at home.

Conclusion

This case demonstrates successful non-surgical management of a complex combination of

Type B thoracoabdominal aortic dissection.
Fusiform infra-renal abdominal aortic aneurysm.
Partial thrombosis of false lumen.
Dilated ascending and thoracic aorta.

Early diagnosis, multidisciplinary care and strict Bp control were critical in preventing progression and ensuring patient stability.

References

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Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW, Bolen MA et al., Peer Review Committee Members. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. 2022 Dec 13;146(24):e334-e482.

Type B Thoracoabdominal Aortic Dissection (TBAD) with fusiform aneurysm of infra-renal abdominal aorta

Type B Thoracoabdominal Aortic Dissection (TBAD) with fusiform aneurysm of infra-renal abdominal aorta

Sripreethi1*, Merin2

Nightingale Journals

Sripreethi^1*, Merin²