Avant-Garde Endovascular Stent Graft Insertion in Dissected Ascending Thoracic Aortic Aneurysm

Abstract

Current guidelines and regulatory parameters for cardiothoracic surgery in the United States establish that open surgery is the first front line for treating ascending thoracic aortic aneurysms (ATAA). Despite advances in performing endovascular procedures in thoracic aortic aneurysms, there are no approved state-of-the-art techniques that allow endovascular procedures to be performed in ATAA. Thus, thoracic endovascular aortic repair (TEVAR) of the ascending aorta, as we will demonstrate, is a useful and effective technical opportunity for treating high-risk patients with type A dissections, intramural hematomas, and pseudoaneurysms. In this case, an 88-year-old female patient was consulted due to a preliminary diagnosed descending thoracic aortic aneurysm. As a result of uncertainty regarding the initial diagnosis, abdominal-pelvic and chest computed tomography scan tests contradicted the original conclusion and surprisingly yielded a different scenario; in fact, the patient had a dissected ATAA. Using the TEVAR procedure, the patient’s ATAA was treated with a thoracic GORE TAG endograft stent (W. L. Gore & Associates, Inc., Newark, DE, USA). Four weeks later, the aneurysm was completely thrombosed, and the stent-graft was properly in place.