Chimney thoracic endovascular repair for anastomotic leakage after ascending aortic replacement for acute type A aortic dissection: a case report

BACKGROUND   : Anastomotic leakage at the distal anastomotic site after surgery for acute type A aortic dissection (AAD) occasionally leads to malperfusion or false lumen dilatation in the remnant dissected aorta. Open surgery remains the optimal therapy; however, subsequent surgery with re-sternotomy is excessively invasive in elderly and frail patients. CASE PRESENTATION: We report the case of an 81-year-old woman who was treated with chimney thoracic endovascular aortic repair (TEVAR) for anastomotic leakage after ascending aortic replacement for AAD. A pressure difference between the upper and lower limbs appeared after the primary surgery, and a computed tomography scan showed a stenotic true lumen in the descending aorta due to a "new tear" at the distal anastomotic site. Chimney TEVAR was performed to direct blood flow into the aortic true lumen in order to restore compromised blood flow to lower body because open surgery is excessively invasive for elderly and frail patients. No endoleak and a better expanded true lumen were detected after the subsequent surgical intervention. CONCLUSIONS: Chimney TEVAR combined with an arch debranching procedure for sealing the new entry at the distal anastomotic site after ascending aortic replacement for AAD may be a viable option for high-risk patients.