Endovascular Rescue Aortic Fenestration After Accidental False Lumen TEVAR in Type B Dissection

Area of Science:

• Cardiovascular Surgery
• Endovascular Interventions
• Aortic Dissection

Background:

• Thoracic endovascular aortic repair (TEVAR) is a standard treatment for acute aortic dissection.
• Unintended false-lumen placement of TEVAR devices can lead to severe complications, including malperfusion.
• Early recognition and intervention are crucial for improving outcomes.

Observation:

• Two patients developed severe visceral and peripheral ischemia 24 hours after TEVAR due to inadvertent false-lumen placement.
• Stepwise subtraction angiography confirmed true-lumen catheterization.
• Retrograde fenestration and distal stent-extension techniques were employed for true-lumen reperfusion.

Findings:

• Endovascular salvage successfully restored true-lumen re-expansion and preserved perfusion in both patients.
• Despite initial hemodynamic success, both patients ultimately succumbed to multiorgan failure and cerebral hemorrhagic infarction.
• Timely recognition and intervention are critical, as high morbidity and mortality are associated with delayed identification of erroneous stent graft placement.

Implications:

• Correct indication and prompt recognition of inadvertent false-lumen stenting are critical to avoid disastrous sequelae.
• Endovascular salvage techniques are feasible for restoring correct perfusion and must be performed in a timely manner.
• While endovascular salvage can restore perfusion, the overall outcomes remain poor if malperfusion is not identified and addressed immediately.