A novel wire-guided prefenestration technique for patients with type B aortic dissection: A case report

Abstract

Rationale: Acute type B aortic dissection (ABAD) is a fatal and severe cardiovascular disease. There are various strategies for dissection involving the left subclavian artery, but limited by the variety and cost of stents, the treatment brings certain obstacles. The aim of this study is to evaluate the effectiveness and safety of the wire-guided prefenestration technique for treating left subclavian artery involvement in patients with arterial dissection. Patient concerns: A 48-year-old man was transferred to our hospital due to persistent chest and back pain that had lasted for 6 hours. Diagnoses: Preoperative computed tomography angiogram (CTA) of the thoracic and abdominal aorta diagnosed with ABAD that affected his left subclavian artery, who needed emergency endovascular treatment due to malperfusion of the lower limb arteries. Interventions: To perform the procedure, a guide wire was inserted through the left brachial artery, exited through the right femoral artery, and then entered the pre-fenestrated hole leading to the main stent. The stent was released while the guide wire was in position, and the left subclavian artery was reconstructed using viabahn. Outcomes: Thoracic endovascular aortic repair was successfully completed for ABAD. A follow-up CT angiogram of the thoracic and abdominal aorta revealed positive vascular remodeling and no signs of significant internal leakage after one month. Lessons: This innovative approach offers a secure and efficient treatment option for aortic dissection in individuals who have undergone left subclavian artery reconstruction.