Emergent Total Endovascular Repair Using Retrograde in Situ Branched Stent Grafting for Ruptured Retrograde Aortic...

An 85-year-old bedridden woman (modified Rankin Scale 5) presented with a contained rupture of an acute retrograde aortic dissection (Type B0,7). Because open surgery was prohibitive due to severe frailty, an emergent total endovascular repair was performed using single-branch, retrograde in situ branched stent grafting (RIBS). Two conformable GORE TAG devices established a Zone 1 seal, and the left common carotid artery was preserved by in situ needle fenestration using a percutaneous transhepatic gallbladder drainage needle and bridged with a VIABAHN VBX stent. To limit embolic risk, cerebral blood flow was transiently interrupted by manual right carotid compression, direct left carotid clamping, and left subclavian balloon occlusion. Operative time was 114 minutes, and the postoperative course was uneventful without neurological deficits. One-year computed tomography showed favorable aortic remodeling and no endoleak. Single-branch RIBS may offer an immediate, off-the-shelf salvage option for high-risk patients when open repair is not feasible.