Endovascular graft deployment in the false lumen of type B dissection

Abstract

TEVAR for complicated type B dissection should be carried out according to a precise and stepwise protocol in institutions familiar with all the different options of conversion to open repair.

Open antegrade aortic stent implantation after surgical treatment in type A aortic dissection

“…Because the stent graft has to be advanced through segments with decreased wall strength, aortic rupture may be caused during the passage or the stent may be released in the false lumen. 1 To minimize these risks, interventional techniques using an antegrade approach via the subclavian artery or the use of a hybrid procedure with open implantation of an aortic stent before placement of the arch prosthesis have recently been described. [2][3][4] We developed a new and safe technique of antegrade stent graft placement via the already implanted prosthesis either after resternotomy or during the original procedure.…”

Successful endoluminal rescue of an endovascular graft unintentionally deployed in the false lumen of Stanford type B aortic dissection

“…There are a few reports of this kind of procedure. [3][4][5] As described in previous reports, surgical removal of the endoprosthesis is feasible but challenging. 5,6 A hybrid operation to maintain blood supply of the visceral arteries would be necessary before the interventional treatment but potentially traumatic.…”

“…However, a dissected and weakened vessel wall may rupture earlier after the stent graft has been unintentionally deployed into the false lumen. Previous reports of endograft deployment into the false lumen were described by Follisa and colleagues 3 and Zhang and colleagues. 4 In both of these studies, the guidewire was placed into the false lumen of the thoracic aorta arch during an attempt of TEVAR, similar to this case.…”

Reverse Frozen Elephant Trunk Procedure for Rescue of a Thoracic Stent-Graft in the False Lumen

“…These complications are often repaired with a hybrid technique [4,7]. In this case, we demonstrated that the unusual complication of device misplacement into the false lumen of an aortic dissection can also be salvaged with a modified FET procedure [5,6].…”

“…Compared with open operations in a meta-analysis, TEVAR had a decreased risk of several common major complications [2]. Proximal aortic complications unique to TEVAR include type 1 endoleaks, device migration, retrograde dissection, and rarely malpositioning in the false lumen [3][4][5][6]. These complications are often repaired with a hybrid technique [4,7].…”