2 CASE PRESENTATION
A 59-year-old man underwent arch replacement using the frozen elephant
trunk technique for acute type A aortic dissection. The postoperative
course was uneventful. However, two weeks later, he complained of
numbness and pain in his right leg during movement. The symptoms were
nonspecific, and the resting ABPI was over 1.00 in both legs.
Contrast-enhanced computed tomography (CT) revealed that the false lumen
was patent with an entry at the Th8 level (Fig. 1a), and an intimal flap
extended to the left common iliac artery, although the true lumen was
maintained and not severely compressed at the periphery.
The Ex-ABPI test (tilt angle 12%, treadmill set at 2.4 km/h) was
performed. Five minutes later, the test was stopped due to limb pain.
Although the right ABPI at rest was 1.00 before exercise (at left
brachial BP 127/69 mmHg), it hit the lowest point of 0.23 at 1 minute
after exercise (at left brachial BP 146/78 mmHg) and recovered to 0.84
at 5 minutes later (at left brachial BP 126/64 mmHg) (Fig. 2a). The left
ABPI and his heart rate remained unchanged during the examination.
Thoracic endovascular aortic repair (TEVAR) was performed to occlude the
proximal entry site (Fig. 1b). Postoperatively, the symptoms of lower
limb pain disappeared completely, and Ex-ABPI tests showed improvement
under the same condition at which he had experienced pain earlier (Fig.
2b).