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Abstract: This article describes an elderly woman who came to our emergency department with sudden onset of chest and back tearing-like pain for 1 day. After excluding other causes of chest pain in the emergency department, a full aortic CTA was performed, which suggested aortic coarctation with a rupture in the distal subclavian artery. The discomfort disappeared completely.
Basic information】Female, 65 years old
Type of disease】Aortic coarctation
Hospital】Liaoning Provincial People’s Hospital
Date of Consultation】May 2021
Treatment plan】Surgical treatment (endoluminal isolation of aortic coarctation) + medication (sodium nitroprusside for injection)
Treatment period】1 week of hospitalization
Effectiveness of treatment】Significant relief of chest and back pain, arteriogram showed complete isolation of aortic coarctation
I. Initial consultation
In May 2021, a 65-year-old female patient came to our emergency room with “sudden onset of chest and back pain for 1 day”. The patient reported sudden onset of chest and back pain at home 1 day ago, which was persistent pressure pain, accompanied by transient syncope and profuse sweating. The patient was immediately given symptomatic antihypertensive and analgesic treatment, and aortic CTA was performed, suggesting aortic coarctation type B. In order to seek surgical treatment, the patient was transferred to our hospital emergency department.
II. Treatment process
After the patient was admitted to the hospital, the relevant examinations were completed, and the patient continued to apply sodium nitroprusside for injection to lower the blood pressure, and after the blood pressure was controlled and stabilized, the patient’s chest and back pain symptoms were relieved. The patient had no history of diabetes, heart disease, or cerebrovascular disease. The patient had an acceptable diet, poor sleep, normal bowel movements, and no significant weight loss. The patient was consulted by the cardiology department, and the CTA of the aorta was reviewed, suggesting: aortic coarctation type B. The rupture was located about 3 cm distal to the left subclavian artery, the abdominal trunk and superior mesenteric artery from the true lumen, the right renal artery from the true lumen, and the left renal artery from the false lumen. After the patient and his family agreed, the right femoral artery was dissected under general anesthesia and intracavitary isolation of the aortic coarctation was performed. The patient returned to the ward with significant relief of chest and back pain, and continued to regulate blood pressure after the operation.
III. Treatment effect
After minimally invasive surgery, the patient’s thoracic back pain was significantly relieved and his blood pressure was more stable. One month after the operation, the patient was reexamined in the outpatient clinic. The patient had no obvious chest and back discomfort, and the aortic CTA indicated post-operative changes in the aortic stent, with good stent position and no obvious endoleak formation.
IV. Notes
I am relieved that the patient’s condition has improved, and at the same time, I should advise the patient to pay attention to strict follow-up observation after discharge. It is suggested that the patient should undergo aortic CTA at 1 month, 6 months and 12 months after surgery, and if there is no abnormality, aortic CTA should be performed every year thereafter in order to detect distant stent complications as early as possible and deal with them in time.
In daily life, avoid strenuous exercise and heavy physical labor, pay attention to rest, rationalize work and rest, avoid staying up late, and pay attention to keeping a relaxed mood, which can help control the stability of the disease.
V. Personal insight
Aortic coarctation is a more dangerous emergency in vascular surgery, which can cause death by rupture of the aorta within a short time if not treated in time.
In this case, the patient is combined with hypertension and poorly controlled blood pressure. At the onset of the disease, there is a sudden onset of pain in the chest and back, and the pain is compressive and persistent, and the emergency blood pressure is often high. This condition should be alerted to aortic coarctation, and the diagnosis of coarctation requires arterial CTA to clarify the location of the rupture. If this patient has a type B coarctation (the rupture is located far from the left subclavian artery), minimally invasive endoluminal treatment is feasible.