A Technique to Avoid Endograft Lumen Narrowing during Endovascular Aortic Arch Repair in Chronic Dissections

The use of retrograde branches during endovascular aortic arch repair in chronic dissections has been associated with endograft lumen compression in the distal arch true lumen. This results in a functional pseudocoarctation, which carries a risk of cardiac failure.

This exemplar case presents a patient treated with a three-branch arch endograft for an anastomotic false aneurysm and a residual chronic arch dissection extending to the supra-aortic trunks. To overcome device compression, a kissing angioplasty of the endograft and the left common carotid artery branch was performed after achieving wire access to the left subclavian artery. This manoeuvre successfully disrupted the distal arch lamella while securing the left common carotid artery bridging stent and maintaining access to the left subclavian artery.

This technique is now routinely performed in all patients presenting with chronic aortic dissections. In the authors' limited recent experience with short-term follow up, no instances of cardiac failure secondary to endograft lumen narrowing have been observed since implementing this manoeuvre. It appears to be a feasible and effective method for overcoming endograft lumen compression and its associated complications.