TREATMENT OF AORTIC DISSECTIONS USING A COMBINATION OF THE STABILISE AND CERAB TECHNIQUES — TECHNICAL NOTE

  • Ryan Gouveia e Melo Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário Lisboa Norte (CHULN); Faculdade de Medicina da Universidade de Lisboa; Centro Académico de Medicina de Lisboa
  • Ruy Fernandes e Fernandes Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário Lisboa Norte (CHULN); Faculdade de Medicina da Universidade de Lisboa; Centro Académico de Medicina de Lisboa
  • Pedro Garrido Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário Lisboa Norte (CHULN); Centro Académico de Medicina de Lisboa
  • Alice Lopes Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário Lisboa Norte (CHULN); Centro Académico de Medicina de Lisboa
  • João Pedro Rato Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário Lisboa Norte (CHULN); Centro Académico de Medicina de Lisboa
  • João Leitão Faculdade de Medicina da Universidade de Lisboa; Centro Académico de Medicina de Lisboa; Serviço de Imagiologia, Centro Hospitalar Universitário Lisboa Norte (CHULN)
  • Luís Mendes Pedro Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário Lisboa Norte (CHULN); Faculdade de Medicina da Universidade de Lisboa; Centro Académico de Medicina de Lisboa
Keywords: STABILISE, CERAB, aortic dissection, Type B aortic dissection, Endovascular repair

Abstract

Introduction: Endovascular treatment of type B aortic dissection has focused on the covering of the proximal entry tear. However, recently, concern has emerged regarding the distal aortic remodeling and new techniques such as the Stent-Assisted Balloon-Induced Intimal Disruption and Relamination (STABILISE) technique have gained more acceptance. We describe a technical note regarding the combination of the STABILISE technique in addition to the Covered Reconstruction of the Aortic Bifurcation (CERAB) technique to achieve complete aortic remodeling.

Methods: The authors describe a stepwise approach regarding the endovascular repair of type B aortic dissections. A simple TEVAR is performed first. If the patient still shows signs of true lumen compression, a STABILISE technique is performed in order to achieve true lumen expansion and complete aortic remodeling. However, in some patients, false lumen perfusion and true lumen compression at the very distal aorta is maintained due to distal comunicating tears. In these patients, if there are still signs of infra-renal aortic or iliac compression/occlusion or distal thrombosis of the false lumen, a simultaneous CERAB is performed.

Conclusion: By combining these techniques, we aim to cover both the proximal tear and the distal comunicating tears resulting in a complete flap apposition, false lumen obliteration, re-expansion of the true lumen and achieve optimal remodeling.

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Published
2019-12-27
Section
Clinical Case