Treatment for acute type B intramural hematoma and patent ductus arteriosus in an adult using a covered stent

A 69-year-old woman was admitted to our emergency department of the first hospital of Jilin University for persistent chest and back pain since 3 days ago. Her family history was negative for any cardiovascular disease, and she had a 20-year history of cigarette smoking. Her initial vital signs were documented as follows: blood pressure 126/62 mm Hg, heart rate 80 beats/min, respiratory rate 18 breaths/min and temperature 36.4 °C. Continuous murmurs were ausculted at the second intercostal space along the left sternal border. Laboratory investigations including routine blood test, coagulation studies and basic metabolic panels revealed no abnormalities. Electrocardiography revealed normal findings. Emergent contrast-enhanced computed tomography angiography (CTA) revealed type B intramural hematoma secondary to atherosclerotic ulcer of proximal descending aorta and coexistence of patent ductus arteriosus (PDA) (Fig. 1a-1d), indicating blood flow from left to right due to contrast jetting in the main pulmonary. A catheter-based approach was planned following multidisciplinary team decision