Endovascular Treatment for False Lumen Expansion Due to a Gutter Leak After Total Arch Replacement Using the...

Acute aortic dissection is a life-threatening condition that requires urgent surgical intervention. The frozen elephant trunk (FET) technique, including the use of the J Graft Frozenix®, is an effective strategy for managing complex aortic pathologies. Approaches for left subclavian artery LSA reconstruction are a critical component of complex aortic arch procedures, such as total arch replacement or thoracic endovascular aortic repair (TEVAR), designed to prevent stroke, spinal cord ischemia, and left arm claudication. Approaches generally fall into the following three categories: in situ reconstruction (direct surgical reimplantation), extra-anatomical bypass, and endovascular techniques (e.g., chimney grafts, fenestration). Recently, the fenestrated FET technique, which creates a fenestration in the stent graft corresponding to the origin of the LSA to preserve anterograde blood flow, has demonstrated favorable outcomes. However, endoleak-related complications have been reported. In this report, we present a case of false lumen expansion caused by an endoleak following the application of the fenestrated FET technique for managing acute Stanford type A aortic dissection. This case involved a dissection extending to the root of the LSA. Postoperative contrast-enhanced computed tomography (CT) demonstrated blood flow into the false lumen. Follow-up contrast-enhanced CT performed every six months revealed lumen enlargement, prompting TEVAR and coil embolization. The postoperative course was uneventful. We performed TEVAR and coil embolization to treat endoleak-induced false lumen expansion following total aortic arch replacement using the fenestrated FET technique for acute type A aortic dissection. Although favorable outcomes have been widely reported for the fenestrated FET technique, this approach may be unsuitable for cases with entry points near the subclavian artery, necessitating careful patient selection and meticulous follow-up.