Retrograde Ascending Dissection After Thoracic Endovascular Aortic Repair Combined With the Chimney Technique and Successful Open Repair Using the Frozen Elephant Trunk Technique

Abstract

The chimney technique can be combined with thoracic endovascular aortic repair (TEVAR) to both obtain an appropriate landing zone and maintain blood flow of the arch vessels. However, surgical repair becomes more complicated if retrograde type A aortic dissection occurs after TEVAR with the chimney technique. We herein report a case involving a 73-year-old woman who developed a retrograde ascending dissection 3 months after TEVAR for acute type B aortic dissection. To ensure an adequate proximal sealing distance, the proximal edge of the stent graft was located at the zone 2 level and an additional bare stent was placed at the left subclavian artery (the chimney technique) at the time of TEVAR. Enhanced computed tomography revealed an aortic dissection involving the ascending aorta and aortic arch. Surgical aortic repair using the frozen elephant trunk technique was urgently performed. The patient survived without stroke, paraplegia, renal failure, or other major complications. Retrograde ascending dissection can occur after TEVAR combined with the chimney technique. The frozen elephant trunk technique is useful for surgical repair in such complicated cases.

A case report of a hybrid procedure (visceral and partial aortic arch debranching) in the treatment of a challenging aneurysm of the thoracoabdominal aorta in the endovascular era

“…Supra-aortic branch angulation and excessive oversizing were determined as a major risk factor for type Ia endoleak. Furthermore, compression and fracture of chimney graft, as well as retrograde type A aortic dissection, can lead to lethal consequences [27,28]. Frequently performed excessive oversizing and ballooning of endografts, as well as more than one chimney graft, carry the greatest risk for retrograde dissection.…”

Hybrid Therapy for Mycotic Aortic Aneurysm with Stent-Graft and Video-Assisted Thoracoscopic Debridement

“…The FET technique, which is usually combined with aortic arch repair, can be used to treat thoracic aortic disease that is unsuitable for TEVAR treatment because of a short proximal landing zone, as well as being used for the treatment of extensive thoracic aneurysms as a single stage operation. The FET technique is also useful for failed cases after TEVAR, such as retrograde aortic dissection, 9) or persistent type 1 endoleak. 10) In the present case, the etiology of the pseudoaneurysm that developed at the proximal edge of the stent-graft was erosion of the stent-graft because there was no sign of reactivation of infection, i.e., repeated culture tests of both blood samples and the discharge from the drainage catheter were all negative during the previous 2 weeks.…”

Fracture of the Bare Spring of a Thoracic Endograft for Type A Aortic Dissection: A Case Report

“…Above all, RTAD is a fatal complication of TEVAR, with an incidence rate ranging from 1.3% to 17.9% [3–8] and a mortality rate ranging from about 33.4% to 42.0% [3,7,9].…”