The “thoracic endovascular aortic repair-first” strategy for acute type A dissection with mesenteric malperfusion: Initial results compared with conventional algorithms

We present the case of a 48-year-old woman with an acute type A aortic dissection that was treated with thoracic endovascular aortic repair at our institution. The patient was found to have a focal type A dissection with pericardial effusion but no tamponade physiology and no involvement of the aortic valve or root. We elected to treat the patient's type A aortic dissection with an endovascular stent because of the patient's favorable anatomy and no evidence of neurologic deficits or signs of distal malperfusion. The patient was successfully treated with an abdominal aortic cuff deployed through the axillary artery. An axillary approach was necessary because of the short length of the delivery sheath preventing a transfemoral delivery. At 2-year follow-up, the patient remains free of complications with computed tomography scan revealing complete false lumen thrombosis and a stable endovascular repair. This report demonstrates a case of acute type A aortic dissection successfully treated using thoracic endovascular aortic repair and illustrates the utility of axillary cannulation for precise deployment of stent grafts in the ascending aorta.

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Different techniques of distal aortic repair in acute type A dissection: impact on late aortic morphology and reoperation1

European Journal of Cardio-Thoracic Surgery ◽

10.1016/s1010-7940(99)00036-6 ◽

1999 ◽

Vol 15 (4) ◽

pp. 496-501 ◽

Cited By ~ 37

Author(s):

B. Nguyen ◽

M. Müller ◽

B. Kipfer ◽

P. Berdat ◽

B. Walpoth ◽

...

Keyword(s):

Type A ◽

Acute Type ◽

Acute Type A Dissection ◽

Aortic Repair ◽

Type A Dissection ◽

Aortic Morphology

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Type A aortic dissection after ‘zone 0’ thoracic endovascular aortic repair for type 1 hybrid aortic arch replacement of arch aneurysm

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa508 ◽

2020 ◽

Vol 2020 (12) ◽

Author(s):

Sung Joon Han ◽

Man-Shik Shim ◽

Woo Sik Han ◽

Hyun Jin Cho ◽

Min-Woong Kang ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Type A ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Type I ◽

Acute Type ◽

Type A Aortic Dissection ◽

Aortic Repair ◽

Arch Aneurysm

Abstract The recent rise in minimally invasive cardiovascular procedures is being accompanied by an increase in related complications. We report on an acute type A aortic dissection performed in an 82-year-old man 1 week after staged ‘zone 0’ hybrid thoracic endovascular aortic repair (TEVAR). Previously, the patient had undergone type I hybrid arch debranching and staged ‘zone 0’ TEVAR for an aortic arch aneurysm. ‘Zone 0’ TEVAR after type I hybrid debranching might increase the risk for aortic injury on the residual native aorta and should, therefore, be closely followed up to enable the early diagnosis of complications.

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