Stent-assisted balloon-induced intimal disruption and relamination in complicated chronic residual type B aortic dissection after frozen elephant trunk treatment

Abstract

CASE REPORT: a 77-year-old man presented to our Emergency Department for worsening dyspnea. A chest CT scan showed a type A aortic dissection with a dilatation of the ascending and descending aorta. After evaluating the case with cardiac surgeons, it was decided to perform an aortic arch replacement through the frozen elephant trunk technique. Three months after cardiac surgery, a TC scan showed a residual 58 mm dissecting aneurysm of the descending thoracic aorta and a collapse of the true lumen so we decided to perform an endovascular treatment of the thoracoabdominal aorta according to the STABILISE technique. Due to the impossibility of cannulating the left renal artery (originating from the false lumen), a partial dilation of the dissecting stent was performed at the origin of the renal arteries, maintaining the communication between true and false lumen at the level of the aortic bifurcation.

DISCUSSION: the STABILISE technique can be applied safely and effectively even in selected cases of residual chronic aortic dissection, constituting a safe and effective alternative to open thoracoabdominal surgery.

CONCLUSIONS: the presence of a proximal artificial neck without proximal tears in the aortic arch can be a great advantage for subsequent endovascular interventions. It is therefore desirable to design a common surgical strategy within an aortic team to achieve a more favorable preoperative anatomy.