FALSE LUMEN BRANCHED STENT GRAFT IMPLANTATION FOR REPAIR OF A DISSECTING THORACOABDOMINAL AORTIC ANEURYSM

  • Joana Catarino Serviço de Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
  • Gonçalo Alves Serviço de Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
  • Frederico Gonçalves Serviço de Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
  • Rita Ferreira Serviço de Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
  • Ricardo Correia Serviço de Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
  • Rita Bento Serviço de Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
  • Maria Emília Ferreira Serviço de Cirurgia Vascular, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal
Keywords: Thoracoabdominal aneurysm, Chronic type B dissection, Frozen elephant trunk, False lumen

Abstract

Introduction: It is estimated that approximately 20 to 40% of patients with chronic type B aortic dissection (CTBAD) develop enlargement of the FL that warrants treatment. The standard endovascular treatment usually involves implant of a stent graft into the true lumen of the dissection in an effort to exclude the false lumen, with less morbidity than open surgery.

Clinical case: The patient was a 65 year old male, with a prior history of hypertension, dyslipidemia and chronic kidney disease. He was referred to our vascular center for a CTBD, with thoracoabdominal aneurysm degeneration (Crawford type II) with a maximum diameter of 85mm. The celiac trunk, superior mesenteric and right renal artery arose from the false lumen and left renal artery from the true lumen. A three stage procedure was planned. The patient was first submitted to a carotid-subclavian bypass. Subsequently, a frozen elephant trunk procedure was undertaken and the TEVAR component was intentionally deployed on the false lumen. Lastly, a customized branched stent graft was implanted into the false lumen, with the right renal artery catheterized through a fenestration created for the effect. The angioCT at 1 month showed adequate proximal and distal sealing and permeable visceral branches. The true lumen was partially thrombosed.

Conclusion: Implant of a branched graft into the false lumen of an aortic dissection in order to exclude a thoracoabdominal aortic aneurysm is possible, and can be a solution, with successful exclusion of the aneurysmal degeneration. The durability of this solution remains largely unknown and cautious follow-up is needed.

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References

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Published
2021-06-03
Section
Clinical Case

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