[Endovascular Treatment for Stanford Type B Aortic Dissection with Recurrent Malperfusion Three Months after Thoracic...

We report a case of a 49-year-old man with distal stent-graft-induced new entry (d-SINE) three months after first thoracic endovascular aortic repair( TEVAR) for acute complicated type B aortic dissection (acTBAD). The d-SINE led to acTBAD recurrence of acTBAD, resulting in malperfusion of the lower limbs and kidneys. The d-SINE was observed in the aorta at the Th8 level, and there was an obvious re-entry in the left common iliac artery( CIA). Additional TEVAR was performed using a modified extended provisional extension to induce complete attachment (e-PETTICOAT). Without balloon dilation, a straight stent graft (SG) was inserted into the aorta at the level of superior to the celiac trunk, then a bifurcated SG was placed from below the renal artery( RA) to the CIA, and finally a bare stent was inserted between them. The d-SINE and retry tears of the acTBAD were closed simultaneously. Despite extensive stent graft placement, we were able to improve the malperfusion of the lower limbs and kidneys and prevent aortic rupture without causing neurological complications. No SINE occurred, and good aortic remodeling was achieved from the left subclavian artery( LCA) to the CIA 14 months after the additional TEVAR.