Complete Aortic Endovascular Repair.

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Interventional Cardiology

Background:

• Type A aortic dissection requires timely intervention, often with ascending aortic replacement.
• Postoperative complications can include the development of downstream aortic aneurysms, posing significant treatment challenges.
• Patients unfit for open repair have limited therapeutic options for extensive aortic pathology.

Observation:

• A 75-year-old male, previously treated for type A aortic dissection with ascending aortic replacement, developed progressive aortic arch and thoraco-abdominal aneurysms.
• The patient was deemed unsuitable for conventional open surgical repair due to comorbidities.
• The aneurysms enlarged significantly within six months of the initial surgery.

Findings:

• A staged surgical strategy was successfully employed, combining open and endovascular techniques.
• The first stage involved open surgery for extra-anatomical supra-aortic trunk reconstruction.
• Subsequent stages utilized endovascular branched repair for the ascending aorta, arch, and descending aorta, followed by fenestrated endovascular repair for the thoraco-abdominal and infrarenal aorta.

Implications:

• This multi-stage approach expands treatment possibilities for complex aortic pathologies previously considered untreatable.
• It demonstrates the feasibility of combining open and advanced endovascular techniques in high-risk patients.
• This case highlights a potential paradigm shift in managing extensive aortic aneurysms post-dissection.