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Conventional repair and operative stent-grafting for acute and chronic aortic dissection
Takeshi Miyairi1, Mikio Ninomiya, Munemoto Endoh
1Department of Cardiothoracic Surgery, University of Tokyo, Japan. tmiyairi-tky@umin.ac.jp
Insights
This study combined conventional graft replacement and stent-grafting for complex aortic dissection. The procedure successfully treated both ascending and descending aorta issues, leading to a thrombosed false lumen.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Aortic Disease
Background:
- Complex aortic dissection involving both ascending (DeBakey type II) and descending (DeBakey type IIIb) aorta presents significant surgical challenges.
- Concomitant surgical approaches are often necessary for comprehensive treatment of extensive aortic pathologies.
Observation:
- An 82-year-old female patient presented with acute DeBakey type II and chronic DeBakey type IIIb aortic dissections.
- The patient underwent simultaneous conventional graft replacement of the ascending aorta and endovascular stent-grafting of the proximal descending aorta.
Findings:
- Postoperative imaging confirmed successful replacement of the ascending aorta with a prosthesis.
- The stent-graft in the descending aorta was well-expanded, and the false lumen was thrombosed, indicating successful sealing and exclusion.
Implications:
- This combined surgical-endovascular approach offers a viable strategy for managing complex, extensive aortic dissections.
- Successful treatment of both ascending and descending aortic segments in a single procedure can improve patient outcomes and reduce the need for staged interventions.
Abstract:
Conventional graft replacement of the ascending aorta and surgically endovascular stent-grafting of the proximal descending aorta were performed concomitantly in a 82-year-old woman with an acute DeBakey type II aortic dissection and a chronic DeBakey type IIIb aortic dissection. Postoperative computed tomography and angiography showed the adequately replaced ascending-aortic prosthesis, the well-expanded stent-graft, and the thrombosed false lumen in the descending aorta.