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Management and follow-up of patient with circumferential type B aortic dissection using GORE thoracic-branch

Aldin Malkoc1,2, Daniel L Burke1, Iden Andacheh1

  • 1The Division of Vascular Surgery, Department of Surgery, Kaiser Permanente Fontana Medical Center, 9961 Sierra Ave., Fontana, CA 92335, USA.

Radiology Case Reports
|November 25, 2024
PubMed

Insights

High-risk Type B aortic dissection can be treated with thoracic endovascular aortic repair (TEVAR) using a staged carotid bypass and a specialized graft for zone 1 landing, improving outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Endovascular Interventions

Background:

  • Type B aortic dissection with high-risk features necessitates intervention to prevent rupture.
  • Traditional thoracic endovascular aortic repair (TEVAR) for zone 1 landing poses stroke risks due to extensive aortic arch debranching.
  • Advancements in endovascular grafts offer optimized solutions for complex aortic dissections.

Observation:

  • A 53-year-old male presented with circumferential Type B aortic dissection and high-risk features.
  • The patient underwent a staged procedure involving right-to-left carotid bypass.
  • Subsequent thoracic endovascular aortic repair (TEVAR) utilized a GORE Ⓡ TAG Ⓡ Thoracic Branch Endoprosthesis for zone 1 proximal landing.

Findings:

  • The staged approach successfully managed the complex dissection.
  • Zone 1 proximal landing was achieved with the thoracic branch endoprosthesis.
  • This technique mitigated the need for extensive debranching, reducing stroke risk.

Implications:

  • This case demonstrates a viable, less invasive endovascular strategy for high-risk Type B aortic dissections.
  • The use of thoracic branch endoprostheses facilitates zone 1 TEVAR in challenging anatomy.
  • This approach may improve safety and efficacy in treating complex aortic dissections.

Keywords:
AortaAortic dissectionType BZone 1

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