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

Ma, Xiaochi; Fu, Weiguo; Ma, Yun; Karmacharya, Ujit; Zhao, Jun

doi:10.1016/j.jtcvs.2015.10.083

Cited by 7 publications

(6 citation statements)

References 8 publications

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“…In this patient entries were multiple, however none was located between the first tear near the LSA and the second tear near the SMA, thus the potential of traversing back and forth should be minimal. Even if it did happen, the effect might not be clinically significant since true-false-true deployment has been previously reported with good clinical outcome [4] , [10] .…”

Section: Discussionmentioning

confidence: 95%

“…While generally it is not too difficult to perform in case of aortic aneurysm, it might be really difficult in complicated cases of aortic dissection. Enlarged false lumen, compressed true lumen and the presence of multiple entry tears might cause preferential direction of the wire to the false lumen and may increase the risk of rupture, retrograde dissection and deployment of stent graft in the false lumen [2] , [3] , [4] , [5] .…”

Section: Introductionmentioning

confidence: 99%

“…There have been several methods to make sure the true lumen course of the wire, including inserting wire from right brachial artery down to the femoral artery or using imaging modalities such as trans-oesophageal echocardiography (TOE) or Intravascular Ultrasound (IVUS), all of which has its advantages and drawbacks [4] . In this report, we would like to introduce a simple looping wire technique to facilitate true lumen wiring during TEVAR in type B aortic dissection (TBAD) with aneurysmal degeneration.…”

Section: Introductionmentioning

confidence: 99%

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Looping wire technique to facilitate true lumen wiring during TEVAR in type B aortic dissection with aneurysmal degeneration: A case report

Adiarto

Siddiq

Indriani

et al. 2022

International Journal of Surgery Case Reports

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Introduction and importance Wiring true lumen during Thoracic Endovascular Aortic Repair (TEVAR) is sometimes difficult in complicated Type B Aortic Dissection (TBAD). Case presentation We treated a TBAD patient with large false lumen, compressed true lumen and multiple entries. After repeated wire misdirection to false lumen, we tried a new technique in which the wire in the false lumen was looped after entrance to true lumen and pushed distally. The looped wire was then used as guide to advance a second wire to the ascending aorta. TEVAR could then be completed with good result. Discussion Wiring the true lumen might be one of the most challenging steps during TEVAR in complicated TBAD. Several methods have been used to overcome the problems, but the cost and availability might be a problem in some countries. The looping wire technique may serve as an alternative method of guiding the process of wiring the true lumen during complicated TEVAR. Conclusion Looping wire technique can be used as an alternative method to facilitate true lumen wiring during TEVAR.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Looping wire technique to facilitate true lumen wiring during TEVAR in type B aortic dissection with aneurysmal degeneration: A case report

Adiarto

Siddiq

Indriani

et al. 2022

International Journal of Surgery Case Reports

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“…More generally, in the absence of an intimal tear, fenestration of the dissection membrane may be performed using a Rösch-Uchida needle, radiofrequency puncture needle, 10,11 or a dedicated re-entry catheter. [12][13][14] In 2014, Bertoglio et al also described neofenestration using a standard or IVUSguided reentry device in either the TL or FL, while a balloon simultaneously inflated in the opposite lumen to stabilize the lamella provided needle counterforce, and prevented displacement of the lamella away from the reentry needle. 3 In our rescue cases, a transbrachial antegrade endovascular access to the aorta may have reduced contrast exposure and procedure time using a through-and-through brachial-femoral wire to enable retrograde delivery of the TEVAR extension across the aortic septum.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Endovascular Rescue Aortic Fenestration After Accidental False Lumen TEVAR in Type B Dissection

et al. 2022

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Purpose: Unintended false-lumen thoracic endovascular aortic repair (TEVAR) is under-reported and often fatal. We present percutaneous endovascular rescue techniques for true-lumen reperfusion with strategies to address the peripheral artery perfusion needs unique to each case. Case Report: Two patients deteriorated 24 hours after uncomplicated and complicated acute aortic type-B dissection TEVAR treatment at a tertiary community hospital. Reevaluation of index and repeated imaging studies revealed inadvertent false-lumen TEVAR with severe visceral and peripheral ischemia. Stepwise subtraction angiography was used to confirm continuous true-lumen catheterization from femoral puncture into the thoracic aorta. Retrograde fenestration distal to the misplaced TEVAR from the true- into the false-lumen allowed for snorkeling by distal stent-extension across the dissection membrane. In one case, TEVAR stent graft extension resulted in true-lumen re-expansion and in the other case, bare-metal stent-extension for stabilization of the dissection membrane resulted in true-lumen re-expansion in addition to preservation of visceral and peripheral perfusion via the false-lumen. Despite excellent acute hemodynamic results and initial signs of recovery, both patients eventually died (multiorgan failure; cerebral hemorrhagic infarction). Conclusion: Correct indication and prompt recognition of potential inadvertent false-lumen stenting is critical to avoid disastrous sequelae, for example, malperfusion. Endovascular salvage is feasible for restoration of correct perfusion and must be performed in a timely manner. Clinical Impact Clinically apparent, complicated type-B dissection necessitates instantaneous treatment. Prerequisite for an endovascular approach is a true-lumen guidewire continuously from access to the ascending aorta. DSA after TEVAR and prompt clinical re-evaluation are to verify effective visceral and peripheral restoration of blood flow. Despite these measures, inadvertent false-lumen TEVAR may occur rarely. Immediate recognition may allow for timely true-lumen re-expansion using percutaneous endovascular salvage techniques e.g. retrograde fenestration from the true- into the false-lumen for distal snorkeling of the misplaced TEVAR across the dissection membrane. However, morbidity and mortality are very high, if erroneous stent graft placement is not identified early.

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Thoracic Endovascular Aortic Repair into the False Lumen in Chronic Aortic Dissection

Kamman

Williams

Patel

2017

Annals of Vascular Surgery

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

Abstract: Successful endoluminal treatment of endovascular graft deployed in the false lumen. Central Message We describe TEVAR in which the stent graft was deployed into the false lumen and rescued by a fenestration procedure called the ''homing technique.'' See Editorial Commentary page e45.

Cited by 7 publications

References 8 publications

Looping wire technique to facilitate true lumen wiring during TEVAR in type B aortic dissection with aneurysmal degeneration: A case report

Looping wire technique to facilitate true lumen wiring during TEVAR in type B aortic dissection with aneurysmal degeneration: A case report

Endovascular Rescue Aortic Fenestration After Accidental False Lumen TEVAR in Type B Dissection

Thoracic Endovascular Aortic Repair into the False Lumen in Chronic Aortic Dissection

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