AUTOPSY OF AORTIC DISSECTION AFTER TEVAR INSTALLATION: A CASE REPORT

Aortic dissection is a condition in which there is a tear in the aorta’s tunica intima layer, leading to separation between the tunica intima and the tunica media, forming a false lumen. The incidence of aortic dissection is reportedly 5-30 cases per 1 million people per year. Thoracic endovascular aortic repair (TEVAR) is a recommended first-line therapy for patients with type B aortic dissection. The reported 30-day mortality rate and major complication rate with TEVAR are 5%-7% and 8%-10%, respectively. We report an autopsy of a 60-year-old German man diagnosed with Stanford type B (DeBakey type III) aortic dissection who underwent a debranching aorto-innominate-carotid graft (Y-graft) and TEVAR surgery. The external examination revealed postsurgical scars on the chest and left inguinal region along with injection marks on both upper extremities. The internal examination revealed blood inside the thorax; heart filled with blood and blood clots; cardiac enlargement; a constricted left coronary artery; an aortic wall laceration; separation of the tunica intima from the tunica media and adventitia throughout the ascending, descending, and abdominal aorta, forming a false lumen containing blood clots; atherosclerosis; and signs of damaged internal organs. There were some vascular Y-graft anastomoses from the ascending aorta to the end of the brachiocephalic artery and just before the branching of the left common carotid and left subclavian arteries. There was also an endovascular graft in the aortic lumen from the aortic arch to the thoracic aorta. Histopathological examination revealed an acute myocardial rupture, atherosclerosis in the left coronary artery, dissection of the aorta accompanied with erythrocyte infiltration in the aortic wall, and signs of internal organ congestion.