Page 79 - JCTR-11-1

Journal of Clinical and

Translational Research

CASE REPORT
The importance of clinical and radiological

follow-up after conservative treatment of
iatrogenic type A aortic dissection: A case report

Lars Niclauss , Filip Dulguerov* , Ziyad Gunga , Anna Nowacka ,
and Matthias Kirsch
Department of Cardiovascular Surgery, University Hospital of Lausanne, Lausanne, Vaud,
Switzerland

Abstract
Background: Iatrogenic type A dissections can be managed conservatively, but
clear guidelines for treatment are lacking. Case presentation: This case illustrates
a borderline situation that necessitated a change in treatment approach. A patient
underwent endo-prosthetic treatment for an aneurysm. During the insertion of
a guiding catheter through the axillary artery, the ascending aorta was dissected,
*Corresponding author: with contrast injected into the vascular wall. Due to the mechanism of injury and the
Filip Dulguerov absence of an intra-aortic intimal tear (as evidenced by contrast stagnation in the
(filip.dulguerov@chuv.ch) false lumen), conservative management was initially chosen. A follow-up computed
Citation: Niclauss L, Dulguerov F, tomography (CT) scan showed complete resolution after 1 month. However,
Gunga Z, Nowacka A, Kirsch M. 10 days later, the patient was readmitted with acute chest pain, and a new CT scan
The importance of clinical and
radiological follow-up after revealed an acute dissection, with a free-moving intimal flap in the ascending
conservative treatment of aorta, requiring emergency surgery. Current guidelines recommend surgery for
iatrogenic type A aortic dissection: iatrogenic type A dissections that extend or propagate several centimeters into the
A case report. J Clin Transl Res.
2025;11(1):73-76. ascending aorta. However, these guidelines do not account for the mechanism of
doi: 10.36922/jctr.24.00048 injury, the localization, or the size of the intimal tear. Conclusion: In this case, the
Received: July 30, 2024 assumption of spontaneous healing with an intact intima was initially supported.
However, further developments highlight the importance of clinical and radiological
1st revised: September 19, 2024 follow-up, regardless of the injury’s mechanism. Relevance for patients: Iatrogenic
2nd revised: November 11, 2024 aortic dissection is a highly complex condition that requires close monitoring and, if
Accepted: December 25, 2024 necessary, a reassessment of the chosen treatment strategy.
Published online: February 3,
2025 Keywords: Intravascular catheterization; Intimal tear; Iatrogenic type A aortic dissection;
Copyright: © 2025 Author(s). Mechanism of injury; Conservative management; Clinical follow-up; Radiological
This is an open-access article follow-up; Treatment guidelines
distributed under the terms of the
Creative Commons Attribution
Non-Commercial 4.0 International
(CC BY-NC 4.0), which permits all
non-commercial use, distribution, 1. Background
and reproduction in any medium,
provided the original work is Iatrogenic type A aortic dissections due to intravascular catheterization are often
properly cited. managed conservatively, in contrast to iatrogenic dissections caused directly by open-
Publisher’s Note: AccScience heart surgery or transcatheter aortic valve implantation. However, clear treatment
Publishing remains neutral with guidelines for this clinical context, which could guide the decision to pursue or avoid
regard to jurisdictional claims in
published maps and institutional a conservative approach, are lacking. The present case illustrates a borderline situation
affiliations that ultimately led to a change in the treatment strategy.

Volume 11 Issue 1 (2025) 73 doi: 10.36922/jctr.24.00048