Ces radiol. 2019, 73(1):30-36 | DOI: 10.55095/CesRadiol2019/006

Endovascular fenestration of aortic dissection membrane after failed open total aortic arch replacementCase report

Veronika Kozáková¹, Jan Raupach², Vendelín Chovanec², Petr Hoffmann², Jan Vojáček³

¹ Lékařská fakulta UK, Hradec Králové, studentka 5. ročníku všeobecného lékařství

² Radiologická klinika LF UK a FN, Hradec Králové

³ Kardiochirurgická klinika LF UK a FN, Hradec Králové

Acute type A aortic dissection (DAA) is a life-threatening condition which affects ascending aorta but may extend into the arch and descending aorta. Most patients with type A dissection are managed surgically. The standard treatment is open surgical repair through median sternotomy and involves segmental resection of the primary intimal tear and reconstitution of the aorta with interposition of a synthetic vascular graft. In case of extensive aortic disease involving both the aortic arch and the descending thoracic aorta a more aggressive treatment may be used, usually consisting of total arch replacement. The Frozen Elephant Trunk (FET) is nowadays a common treatment for patients with complex thoracic aortic disease, including aortic dissection. The FET uses a hybrid prosthesis and this approach is based on conventional replacement of the upstream aorta by the proximal segment, while the distal segment is implanted into the descending aorta in a single-stage procedure. This surgical approach has its own potential complications, which must be detected early and treated in a timely manner.
Here, we report a case of a 51-year-old male with complicated acute type A aortic dissection. The patient inicially underwent supracoronary and total aortic arch replacement with the use of the FET technique, which resulted in inadvertent landing of the distal part of the FET into the lumen. This case was further complicated by the development of the distal malperfusion and multiple organ failure. The first postoperative day, the patient underwent an urgent endovascular fenestration of the aortic dissection performed by use of re-entry catheter Outback. The endovascular fenestration with additional stent-grafts implantation immediately restored true lumen perfusion with flow improvement into the visceral vessels.

Keywords: ascending aorta dissection, endovascular fenestration, Frozen Elephant Trunk, re-entry catheter

Accepted: March 25, 2019; Published: March 1, 2019  Show citation