Total endovascular repair of an intraoperative stent-graft deployed in the false lumen of Stanford type A aortic dissection: A case report  

作　　者：Xu-Ran Li Yuan-Hao Tong Xiao-Qiang Li Chang-Jian Liu Chen Liu Zhao Liu 

机构地区：[1]Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School

出　　处：《World Journal of Clinical Cases》2020年第5期954-962,共9页世界临床病例杂志

基　　金：Supported by National Natural Science Foundation of China,No.81600375

摘　　要：BACKGROUND A 46-year-old male underwent ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection in 2016.However,an intraoperative stent-graft was deployed in the false lumen inadvertently.This caused severe iatrogenic thoracic and abdominal aortic dissection,and the dissection involved many visceral arteries.CASE SUMMARY The patient had pain in the chest and back for 1 mo.A computed tomography scan showed that the patient had secondary thoracic and abdominal aortic dissection.The ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection were performed 2 years prior.An intraoperative stent-graft was deployed in the false lumen.Endovascular aneurysm repair was performed to address this intractable situation.An occluder was used to occlude the proximal end of the true lumen,and a covered stent was used to direct blood flow back to the true lumen.A three-dimensional printing technique was used in this operation to guide prefenestration.The computed tomography scan at the 1stmo after surgery showed that the thoracic and abdominal aortic dissection was repaired,with all visceral arteries remaining patent.The patient did not develop renal failure or neurological complications after surgery.CONCLUSION The total endovascular repair for false lumen stent-graft implantation was feasible and minimally invasive.Our procedures provided a new solution for stent-graft deployed in the false lumen,and other departments may be inspired by this case when they need to rescue a disastrous stent implantation.BACKGROUND A 46-year-old male underwent ascending aortic replacement, total arch replacement, and descending aortic stent implantation for Stanford type A aortic dissection in 2016. However, an intraoperative stent-graft was deployed in the false lumen inadvertently. This caused severe iatrogenic thoracic and abdominal aortic dissection, and the dissection involved many visceral arteries.CASE SUMMARY The patient had pain in the chest and back for 1 mo. A computed tomography scan showed that the patient had secondary thoracic and abdominal aortic dissection. The ascending aortic replacement, total arch replacement, and descending aortic stent implantation for Stanford type A aortic dissection were performed 2 years prior. An intraoperative stent-graft was deployed in the false lumen. Endovascular aneurysm repair was performed to address this intractable situation. An occluder was used to occlude the proximal end of the true lumen,and a covered stent was used to direct blood flow back to the true lumen. A three-dimensional printing technique was used in this operation to guide prefenestration. The computed tomography scan at the 1 stmo after surgery showed that the thoracic and abdominal aortic dissection was repaired, with all visceral arteries remaining patent. The patient did not develop renal failure or neurological complications after surgery.CONCLUSION The total endovascular repair for false lumen stent-graft implantation was feasible and minimally invasive. Our procedures provided a new solution for stent-graft deployed in the false lumen, and other departments may be inspired by this case when they need to rescue a disastrous stent implantation.

关 键 词：Type A dissection False lumen stent graft implantation Endovascular repair 3D printing Thoracoabdominal aortic dissection Case report 

分 类 号：R654[医药卫生—外科学]