Total Aortic Arch Debranching with Antegrade Thoracic Endovascular Aortic Repair (TEVAR) in Acute Aortic Arch Dissection

Abstract

BACKGROUND The surgical evaluation and management of aortic arch dissections, in the absence of ascending aortic involvement, remains a grey area. It is during these scenarios where thorough evaluation of patient/family history, clinical presentation, but also overall lifestyle, is of immense importance when determining an optimal intervention. CASE PRESENTATION We present a patient with a physically demanding lifestyle, history of medical non-adherence, and family history of aortic dissections who presented with acute aortic arch dissection. He was spared a total arch replacement, by undergoing a hybrid approach of total aortic debranching with antegrade Thoracic Endovascular Aortic Repair (TEVAR). The patient was able to benefit from reduced cardiopulmonary bypass (CPB) time, avoidance of total aortic cross clamp, circulatory arrest, and hypothermic circulation for ischemic organ protection. CONCLUSIONS This patient’s unique composition of a physically demanding lifestyle, personal history of medical non-adherence, family history of aortic dissection, and clinical presentation required a holistic approach to understanding an ideal intervention would be best suited long-term. Due to this contextualization, the patient was able to be spared a total arch replacement, or suboptimal medical management, by instead undergoing a hybrid-approach with total aortic arch debranching with antegrade TEVAR.