Full metal jacket for complicated type A aortic dissection: complex hybrid surgery management

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Aortic Disease Management

Background:

• Retrograde type A aortic dissection (DeBakey type I) presents complex challenges, particularly with false lumen rupture and limb ischemia.
• Standard treatments may not always ensure complete false lumen remodeling in the abdominal aorta.

Observation:

• A patient with complicated DeBakey type I aortic dissection and right lower limb ischemia underwent fenestration at the aortic bifurcation.
• A hybrid approach involved an elephant trunk procedure and endoluminal stent grafting for the descending thoracic aorta.

Findings:

• Despite primary entry site closure, the false lumen in the abdominal aorta did not remodel.
• Successful placement of bare stents and an aortobisiliac endoprosthesis restored visceral blood flow.
• The patient experienced an uneventful postoperative course at 6-month follow-up.

Implications:

• This case highlights the efficacy of a hybrid endovascular strategy for complex aortic dissections with persistent false lumen issues.
• Fenestration and staged endovascular repair can be a viable option for managing challenging aortic pathologies.
• Preservation of visceral perfusion is crucial for favorable outcomes in these complex aortic interventions.