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[Distal Stent Graft-induced New Entry on the Lesser Curvature of Distal Aortic Arch:Report of a Case]
Toshifumi Saga1, Masataka Koga, Shoichiro Izuka
1Department of Cardiovascular Surgery, Kanto Central Hospital, Tokyo, Japan.
Insights
A rare case of distal stent graft-induced new entry (dSINE) occurred on the lesser curvature of the aorta after frozen elephant trunk (FET) repair. Further thoracic endovascular aortic repair (TEVAR) was successful.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Aortic Aneurysm Research
Background:
- Dissecting thoracic aortic aneurysms require complex surgical repair.
- The frozen elephant trunk (FET) technique is a common approach for total aortic arch replacement.
- Stent graft-induced complications can occur after endovascular repair.
Purpose of the Study:
- To report a rare case of distal stent graft-induced new entry (dSINE) on the lesser curvature of the distal aortic arch.
- To discuss the potential mechanisms behind dSINE occurring on the lesser curvature.
- To highlight the successful management of this rare complication.
Main Methods:
- A 62-year-old male patient with cerebral hemorrhage and dissecting thoracic aortic aneurysm underwent total arch replacement with FET.
- Postoperative follow-up included enhanced computed tomography (CT) scans.
- Diagnosis of dSINE led to subsequent thoracic endovascular aortic repair (TEVAR).
Main Results:
- Enhanced CT at 31 months revealed a dSINE on the lesser curvature of the distal arch, a rare location.
- The patient successfully underwent additional TEVAR to address the dSINE.
- The case presents a unique instance of dSINE on the aortic lesser curvature.
Conclusions:
- dSINE on the lesser curvature after FET repair is a rare but significant complication.
- Understanding the specific mechanisms of dSINE on the lesser curvature is crucial for prevention and management.
- TEVAR can be an effective treatment for dSINE in this location.
Abstract:
A 62-year-old male was admitted for cerebral hemorrhage, enhanced computed tomography (CT) revealed a dissecting thoracic aortic aneurysm in the distal arch. Following cerebral hemorrhage treatment, the patient was referred to our department and underwent a total arch replacement using the frozen elephant trunk (FET) technique. The patient was followed up regularly post operatively at our hospital. Enhanced CT at 31 months post surgery revealed a distal stent graft-induced new entry (dSINE) on the lesser curvature of the distal arch. Additional thoracic endovascular aortic repair (TEVAR) was performed. Although dSINE can be caused by various factors, it is usually seen on the greater curvature of the aorta and is relatively rare on the lesser curvature, as in this case in Japan. We will discuss the mechanisms underlying the development of dSINE on the lesser curvature with reference to the literature.
