scholarly journals Bail-out thoracic endovascular aortic repair for incorrect deployment of frozen elephant trunk into the false lumen

2020 ◽  
Vol 30 (6) ◽  
pp. 947-949
Author(s):  
Motoharu Kawashima ◽  
Yoshikatsu Nomura ◽  
Masamichi Matsumori ◽  
Hirohisa Murakami
Keyword(s):  
Computed Tomography ◽  
False Lumen ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Aortic Repair ◽  
Enhanced Computed Tomography ◽  
Bail Out

Abstract We report a rare case of bail-out thoracic endovascular aortic repair after incorrect deployment of a frozen elephant trunk into the false lumen. A 54-year-old man presented to our department complaining of chest pain. Enhanced computed tomography revealed Stanford type A acute aortic dissection, which had a large entry site at the mid-descending aorta. Emergency total aortic arch replacement with a frozen elephant trunk was performed. Progressive intraoperative acidosis was observed. Immediate postoperative enhanced computed tomography showed that the distal end of the frozen elephant trunk was deployed into the false lumen through the initial tear at the proximal descending aorta. We performed emergency thoracic endovascular aortic repair through a fenestration made into the intimal flap using an Outback LTD re-entry device. The patient was discharged home on postoperative day 67 after a complete recovery.

Retrograde Ascending Dissection After Thoracic Endovascular Aortic Repair Combined With the Chimney Technique and Successful Open Repair Using the Frozen Elephant Trunk Technique

2017 ◽  
Vol 52 (1) ◽  
pp. 80-85 ◽  
Author(s):  
Koji Hirano ◽  
Toshiya Tokui ◽  
Bun Nakamura ◽  
Ryosai Inoue ◽  
Masahiro Inagaki ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Surgical Repair ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Chimney Technique ◽  
Aortic Repair ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

The chimney technique can be combined with thoracic endovascular aortic repair (TEVAR) to both obtain an appropriate landing zone and maintain blood flow of the arch vessels. However, surgical repair becomes more complicated if retrograde type A aortic dissection occurs after TEVAR with the chimney technique. We herein report a case involving a 73-year-old woman who developed a retrograde ascending dissection 3 months after TEVAR for acute type B aortic dissection. To ensure an adequate proximal sealing distance, the proximal edge of the stent graft was located at the zone 2 level and an additional bare stent was placed at the left subclavian artery (the chimney technique) at the time of TEVAR. Enhanced computed tomography revealed an aortic dissection involving the ascending aorta and aortic arch. Surgical aortic repair using the frozen elephant trunk technique was urgently performed. The patient survived without stroke, paraplegia, renal failure, or other major complications. Retrograde ascending dissection can occur after TEVAR combined with the chimney technique. The frozen elephant trunk technique is useful for surgical repair in such complicated cases.

Fate of the Dissected Thoraco-Abdominal Aorta Distal to TEVAR (Thoracic Endovascular Aortic Repair) for Complicated Acute and Subacute Type B Aortic Dissection

2021 ◽  
pp. 152660282110659
Author(s):  
Jowan Nassib ◽  
Kheira Hireche ◽  
Baris Ata Ozdemir ◽  
Pierre Alric ◽  
Ludovic Canaud
Keyword(s):  
Morphological Changes ◽  
False Lumen ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Type B ◽  
Descending Aorta ◽  
Aortic Repair ◽  
Aneurysmal Dilation ◽  
Type B Dissection

Purpose: This study assessed morphological changes in the aortic true and false lumens during follow-up of patients undergoing TEVAR (Thoracic Endovascular Aortic Repair) for complicated acute and subacute type B dissection. The study analyzes the effectiveness of TEVAR in preventing distal aneurysmal progression. Materials and Methods: All patients between 2009 and 2019 undergoing TEVAR for complicated acute and subacute type B dissection at the study institution were retrospectively reviewed. Maximal diameters were measured on the proximal descending aorta right below the left subclavian artery, thoraco-abdominal junction right above the celiac trunk, and infrarenal aortic right above the inferior mesenteric artery, pre-operatively and during follow-up, analyzing either expansion or shrinkage of true and false lumens at these 3 sites. Results: Forty-one patients were included. Thirty-day incidence of death, stroke, paraplegia, and visceral ischemia was, respectively, 8% (n = 4), 6% (n = 3), 2% (n = 1), and 2% (n = 1). Three patients (6%) died from intervention-related cause. Mortality was 17% (n = 8) during a mean follow-up of 54 months. One patient had aneurysmal dilation of the descending aorta needing additional coverage and only 2 (4%) developed thoraco-abdominal aneurysms requiring re-intervention. In the remaining patients, both significant expansion of the true lumen and shrinkage of false lumen were observed at all 3 sites. Conclusion: Proximal coverage of the main entry tear appears to prevent aneurysmal progression in most patients (96%). With such promising results, TEVAR should be considered as a first-line treatment in acute and subacute type B dissection.

Additional frozen elephant trunk as a bailout for a misdeployed frozen elephant trunk in the false lumen in a patient with acute aortic dissection

2019 ◽  
Author(s):  
Koichi Tamai ◽  
Daijiro Hori ◽  
Koichi Yuri ◽  
Atsushi Yamaguchi
Keyword(s):  
Computed Tomography ◽  
Blood Flow ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
False Lumen ◽  
Transoesophageal Echocardiography ◽  
Frozen Elephant Trunk ◽  
True Lumen ◽  
Elephant Trunk ◽  
Descending Aorta

Abstract Using a frozen elephant trunk (FET) in patients with acute aortic dissection is an effective method to induce aortic remodelling after surgery. A 40-year-old man with Stanford type A acute aortic dissection underwent emergency total arch replacement with FET. The FET was inserted into the descending aorta under direct vision. However, transoesophageal echocardiography after the deployment of the FET revealed that it was misdeployed in the false lumen. An additional FET was deployed in the true lumen to redirect the blood flow to the true lumen. The patient was discharged from the hospital without any major complications. Computed tomography 6 months after surgery revealed enhanced aortic remodelling without any signs of stent graft-induced new entry. Additional deployment of a FET into the true lumen could be an option for a misdeployed FET in the false lumen.

scholarly journals Staged coil embolization after thoracic endovascular stent grafting for aneurysmal chronic type B aortic dissection: A case report

2019 ◽  
Vol 7 ◽  
pp. 2050313X1982890
Author(s):  
Takuya Nakayama ◽  
Koji Hattori ◽  
Takuya Hashizume ◽  
Miki Asano
Keyword(s):  
Computed Tomography ◽  
Aortic Dissection ◽  
Coil Embolization ◽  
False Lumen ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Chronic Type ◽  
Aortic Repair

We herein describe a 38-year-old woman with Marfan syndrome and chronic type A aortic dissection. Computed tomography showed that the sinus of Valsalva and thoracoabdominal aorta had a diameter of 62 and 55 mm, respectively. After 7 months of a Bentall operation and total arch replacement with the elephant trunk technique, we performed thoracic endovascular aortic repair for an aneurysm of the descending aorta, but we preserved the retrograde flow into the false lumen because it supplied vessels perfusing the spinal cord. Computed tomography angiography 14 months after thoracic endovascular aortic repair showed that the thoracic aortic diameter had increased to 68 mm. We then performed partial (proximal only) coil embolization of the false lumen. After 6 months, the thoracic aortic diameter had decreased to 60 mm and the spinal cord remained perfused via the distal false lumen. Staged coil embolization after thoracic endovascular aortic repair for aneurysmal chronic type B aortic dissection is feasible and can be beneficial.

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