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Multiple Re-entry Closures After TEVAR for Ruptured Chronic Post-dissection Thoraco-abdominal Aortic Aneurysm
R Kinoshita1, F Ganaha1, J Ito1
1Department of Radiology, Okinawa Prefectural Nanbu Medical Centre, Okinawa, Japan.
EJVES Short Reports
|May 22, 2018
Summary
Closing abdominal and iliac re-entry tears with endovascular aneurysm repair (EVAR) and covered stents is crucial for treating chronic post-dissection thoraco-abdominal aortic aneurysm (TAA). This approach achieves false lumen thrombosis and aneurysm shrinkage, offering an alternative to complex fenestrated/branched endografts.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Aortic Aneurysm Treatment
Background:
- Thoracic endovascular aortic repair (TEVAR) is limited for chronic post-dissection thoraco-abdominal aortic aneurysm (TAA) due to persistent false lumen (FL) retrograde flow.
- Abdominal or iliac re-entry tears contribute to FL patency, hindering successful TEVAR outcomes in TAA.
Observation:
- A case of chronic post-dissection TAA with FL rupture into the thorax was treated.
- Emergency TEVAR closed the primary entry tear.
- Endovascular aneurysm repair (EVAR) with covered stents occluded abdominal and iliac re-entries, including at the renal artery and iliac bifurcation.
Findings:
- The EVAR procedure utilized chimney techniques and aortic extenders to close distal re-entries.
- Despite residual re-entries, complete FL thrombosis at the rupture site was achieved.
- Follow-up CT scans demonstrated significant FL shrinkage.
Implications:
- Adjunctive techniques to close distal re-entries are necessary for complete FL exclusion in post-dissection TAA, especially in rupture cases.
- This multi-re-entry closure technique using readily available devices offers a viable endovascular alternative for TAA treatment, particularly in emergencies.
- It presents a practical alternative to complex fenestrated or branched endografts, which have limited widespread use due to technical challenges.
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