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Novel and Innovative Hybrid Technique for Type A Aortic Dissection
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Total Endovascular Aortic arch Replacement with Chimney/Sandwich Techniques.

Gabriela Teixeira1, Arlindo Matos1, Rui de Almeida1

  • 1Angiology and Vascular Surgery Department, Centro Hospitalar do Porto, Oporto, Portugal.

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Summary

Total endovascular aortic arch repair using chimney/sandwich techniques offers a less invasive alternative to open surgery for complex aortic dissections. This case demonstrates its feasibility and effectiveness in managing challenging aortic pathologies with successful outcomes.

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Area of Science:

  • Cardiovascular Surgery
  • Endovascular Techniques
  • Aortic Aneurysm Management

Background:

  • Traditional open total zone 0 replacement of the aortic arch is a high-risk procedure with significant morbidity and mortality.
  • Endovascular approaches offer a less invasive alternative, particularly in urgent situations.

Observation:

  • A 49-year-old patient with chronic type B aortic dissection and a descending thoracic aortic aneurysm presented with an enlarging, symptomatic aneurysm after an unsuccessful prior endovascular repair.
  • The patient underwent an extended thoracic endovascular aortic repair with zone 0 coverage, incorporating chimney and sandwich techniques for branch revascularization.

Findings:

  • The procedure involved endovascular repair of the aortic arch zone 0, with chimney grafts for the brachiocephalic trunk and left carotid artery, and a periscope sandwich technique for the left subclavian artery.
  • Post-procedure imaging at one month and one year revealed no endoleaks, patent branch vessels, and successful exclusion of the aneurysm.

Implications:

  • Total endovascular zone 0 aortic arch repair with chimney/sandwich techniques is a feasible and less invasive option for complex aortic arch pathologies.
  • This approach may reduce the morbidity and mortality associated with traditional open surgical repair.
  • Successful management of complex aortic dissection and aneurysm with endovascular techniques highlights advancements in minimally invasive cardiovascular surgery.