Case Report on IVUS of Total Visceral Ischemia Guided Rescue After Endovascular Stent Grafting for Stanford Type B Aortic Dissection

This case aims to report and analyze the diagnosis and management of total visceral ischemia caused by aortic intimal intussusception (AII) following thoracic endovascular aortic repair (TEVAR) in a patient with Stanford type B aortic dissection, and to explore the usage of intravascular ultrasound (IVUS) in precise rescue. A 47-year-old male with hypertension presented with acute chest and back pain. Computed tomography angiography (CTA) confirmed Stanford type B aortic dissection, and the patient underwent TEVAR. On postoperative day 3, the patient developed abdominal distension, hypoxemia, and severe deterioration of hepatic and renal function (ALT 4485 U/L, AST 4051 U/L, creatinine 259.3 µmol/L), indicating total visceral ischemia. To avoid contrast-induced nephropathy, IVUS was used in the reintervention to clearly diagnose severe distal true lumen compression caused by AII (true/false lumen ratio 6:1). Under IVUS guidance, two bare stents were successfully implanted, and tri-lobe balloon dilation was performed to restore true lumen patency. Post-intervention, visceral ischemia symptoms gradually resolved, and early follow-up CTA confirmed that all visceral arteries were perfused through the true lumen. At the 3-month follow-up, the patient's hepatic and renal function returned to normal (ALT 15 U/L, creatinine 86.1 µmol/L), and he had resumed daily activities. This case confirms the critical role of IVUS in reducing contrast use, accurately evaluating vascular anatomy, and guiding stent deployment, providing a practical reference for the diagnosis and management of complex complications after TEVAR.