Hybrid aortic arch repair for unibody single-branched endograft induced retrograde aortic dissection
Yu Zhang, JIA HU, Peng Yang, Chen Lu.
West China Hospital， Sichuan University, Chengdu, China.
BACKGROUND: To demonstrate the feasibility of a total endovascular aortic repair of a retrograde aortic dissection (RTAD) after acute type B aortic dissection treated with an unibody single-branched stent-graft.
METHODS: A 70-year-old male presented with retrograde aortic dissection and an isolated left vertebral artery. Past medical history was notable for acute type B aortic dissection treated with an unibody single-branched stent-graft. We describe our initial experience of total endovascular aortic repair of RTAD after single-branched stent graft.
RESULTS: Physician-modified extracorporeal bypass was deployed to maintain cerebral perfusion using one 22F sheath and four 10F sheathes. Using right femoral approach, a 34×34×200-mm Valiant thoracic stent-graft was successively introduced and deployed. The innominate (IA), left common carotid (LCCA) and left subclavian arteries (LSA) were then selectively catheterized using in-situ needle fenestration and stented with endografts through bilateral common carotid arteries and right femoral artery approaches. The ILVA was anastomosed to the LCCA in an end-to-side manner. The procedure was technically successful, and the patient had no postoperative complications.
CONCLUSIONS: Castor unibody single-branched stent-graft, which has no proximal bare stent configuration, was less likely to cause RTAD. However, it is a fatal complication with a high mortality rate and requires prompt surgical intervention. Our initial experience of total endovascular aortic repair for unibody single-branched stent-graft induced RTAD, which has never been reported, may provide a minimally invasive alternative for such patients incapable of tolerating surgical repair. LEGEND: Figure A&B Preoperative computed tomography angiography showing the retrograde aortic dissection (asterisk) and previous unibody single-branched stent-graft (pentagram). Figure C The diagram of physician-modified extracorporeal bypass. Figure D In-situ fenestration of supra-arch artery. Figure E The balloon dilatation of the fenestration hole. Figure F Isolated left vertebral artery to left common carotid artery bypass. Figure G The diagram of total endovascular aortic repair of single-branched stent-graft induced RTAD. Figure H Completion angiography confirmed a technical success. Figure I Three-day computed tomography angiography reveal excellent patency of supra-arch branches.
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