[Multi-stage Operations to Thrombose a False Lumen for Chronic Aortic Dissection:Report of a Case]

Area of Science:

• Cardiovascular Surgery
• Vascular Endovascular Therapy
• Aortic Disease Management

Background:

• Initial hemiarch replacement for Stanford type A acute aortic dissection.
• Persistent false lumen patency after initial repair.
• Aortic aneurysm progression over 10 years necessitating reintervention.

Observation:

• Redo total arch replacement and open stent graft placement.
• Development of distal stent graft induced neo entry (dSINE) two years later.
• Patent thoracoabdominal segment of the false lumen.

Findings:

• Successful aortic reconstruction using thoracic endovascular aortic repair (TEVAR) with a combined covered stent graft and bare metal stent.
• Further intervention with endovascular aneurysm repair (EVAR) and coil embolization to address residual false lumen patency.
• Near-complete thrombosis of the false lumen after sequential endovascular procedures.

Implications:

• Demonstrates the feasibility of complex, staged endovascular repairs for aortic dissection complications.
• Highlights the importance of monitoring for late complications like dSINE after aortic surgery.
• Suggests a potential strategy for managing persistent false lumen flow and aneurysm growth in the thoracoabdominal aorta.