ABSTRACT
Distal aortic dissections (in relation to the origin of the left subclavian artery) are complex manifestations of a disease afflicting the aortic wall. Although chest pain and hypertension are nearly ubiquitous at the time of patient presentation, they are frequently managed without intervention solely relying on aggressive betablockade and other pharmacologic agents. However, patient presentation may be complicated by aortic rupture, or ischemia of the mesenteric, renal, or lower extremity circulation in 10-15% of patients with dissections. These patients require urgent therapy. Traditional treatments for acute problems with distal dissection are associated with mortality rates in excess of 50% largely due to the extent of ischemia, the quality of aortic tissue shortly after such an injury, and the magnitude of the required procedure (1-3). Endovascular treatment paradigms have replaced a significant percentage of open procedures, particularly in the setting of critically ill patients (4-7). However, despite the less invasive approach, a multitude of complications may arise as a result of the initial pathophysiologic insult or technical misadventures.
