The kissing stents technique for a patient with chronic type B aortic dissection

Abstract

Video clip is available online.Thoracic endovascular aortic repair has recently become widespread for patients with thoracic aneurysm. For patients with chronic type B aortic dissection, however, in whom the visceral arteries originate from a false lumen, blood flow from the false lumen is not always occluded, and there is concern that aneurysmal enlargement may occur in the false lumen through reentry. 1 We describe here the ''kissing stent'' technique, in which 2 stent-graft main bodies are aligned in a parallel manner and the distal landing of one stent is placed into the true lumen with another stent graft placed into the false lumen. CLINICAL SUMMARYA 67-year-old man with an asymptomatic 72-mm saccular descending aortic aneurysm had a history of acute aortic dissection 12 years earlier and had undergone Ygrafting to the abdominal aortic aneurysm, proximal descending aortic replacement, and total arch replacement. He also had chronic obstructive pulmonary disease, coronary artery disease, and cerebral infarction and was therefore considered at high risk if undergoing open surgery. The aneurysm was located in the middle portion of the descending aorta. The distal descending aorta and thoracoabdominal aorta were double-barreled, and neither lumen was enlarged. The superior mesenteric and right renal arteries originated from the true lumen, and the celiac and left renal arteries originated from the false lumen.An endovascular stent-graft operation was performed. The stent-graft main body (Gore TAG Thoracic Endoprosthesis; W.L. Gore and Associates, Flagstaff, Ariz) was delivered through the true lumen and placed into a prosthetic graft in the proximal descending aorta. The main body of another stent graft of the same size was inserted through the false lumen, with the upper end placed at almost the same level as the first stent graft. The grafts were deployed simultaneously at the same height. To secure the length of the proximal landing, the proximal extension cuff (Zenith Tx2 Thoracic Endoprosthesis; Cook Medical, Bloomington, Ind) was delivered into one side and the other cuff into the other side ( Figure 1). Simultaneous touch-up FIGURE 1. Postoperative diagram. Two stent-graft main bodies were inserted into the true and false lumens of the descending aorta in a parallel fashion.Stent grafts were inserted in parallel fashion, with distal landings in the true and false lumens. Central MessageWe performed a new thoracic endovascular aortic repair, named ''kissing stent'' technique, in a patient with chronic aortic dissection.

Placement of stent grafts with different calibers into the true and false lumens of anastomotic aneurysms after descending aortic replacement for aortic dissection

“…The use of TEVAR in patients with chronic type B aortic dissection, however, remains controversial. As in our case, one study reported that the kissing stent technique for chronic aortic dissection completely preserved blood flow to abdominal branch vessels and excluded the aneurysm by implanting the stent graft landing on the false and true lumen [ 1 ] Indeed, our case with a significant difference in vessel diameter between the true and false lumen was challenging for performing TEVAR only on the true lumen. In contrast to the previous methods of inserting stent grafts of the same diameter, our modified kissing stent technique, insertion of stent grafts with different diameters, was performed.…”