Ascending Aorta Stenting After Off-Pump Aortic Wrapping in Stanford A Retrograde Aortic Dissection

Abstract

We report 4 cases of off-pump ascending aorta wrapping combined with ascending aorta stenting in retrograde Stanford A acute aortic dissection (SAAD). Since 2008, 18 patients have undergone wrapping of the ascending aorta at our institution. Four patients had a persistent circulating false lumen in the ascending aorta after wrapping, with a threat to the aortic root. We chose an endovascular approach with ascending aorta stenting. Follow-up computed tomography showed a reapplication of the intimal flap in the reinforced aorta. Ascending aorta stenting after aortic wrapping for retrograde SAAD is a safe and efficient technique to prevent proximal progression of the dissection.

Off-Pump Wrapping for Acute Type A Aortic Dissection: Alternate Option in Patients Deemed Inoperable

“…Postoperative computed tomography scan imaging showed complete regression of the false lumen in the ascending aorta after surgery, except in 4 patients who underwent successful complementary endovascular stenting due to persistent circulating false lumen. 3 In case of secondary aneurysmal evolution of the non-wrapped aortic arch, we recently reported that 88% of our cohort could be candidates for additional endovascular arch repair. 4

Figure 1 Schematic diagram of an aortic wrapping performed around the dissected ascending aorta using a Teflon (Chemours, Wilmington, DE) plaque.

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