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Updated: Jun 21, 2026

Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
The arch and beyond: bare stents in the ascending aorta
Marcelo Ferreira1, Luiz Lanziotti, Marcelo Monteiro
1SITE - Serviço Integrado de Técnicas Endovasculares, Rio de Janeiro, Brazil. marceloferreira@siteendovascular.com
Purpose:
To describe the management of complications from an unsuccessful hybrid repair of an aortic arch aneurysm.
Case Report:
A 63-year-old man with acute type B dissection and retrograde dissection into the aortic arch underwent emergent hybrid repair, with partial debranching (ascending aorta to left carotid artery bypass) and proximal stent-graft deployment. At 3 months, computed tomography (CT) showed stent-graft migration, causing a large type I endoleak; flow through the patent left subclavian artery (LSA) caused a large type II endoleak. At a second operation, a bilateral subclavian-to-carotid transposition was performed; the LSA was ligated and a Zenith TX2 thoracic endograft was deployed to seal the leak. Recurrent type I endoleak a year later prompted the final endovascular solution: total supra-aortic vessel debranching, proximal stent-graft deployment, and the unprecedented use of bare Z stents in the ascending aorta. CT at 18 months confirmed stable stent-graft position and no endoleak.
Conclusion:
Based on this initial experience, bare Z stents can be used to enhance proximal aortic stent-graft fixation and accommodation within the aortic arch.
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