Hybrid Repair of Chronic Stanford Type B Aortic Dissection with Expanding Arch Aneurysm

Authors

  • Sheena W. Chen MD The George Washington University Hospital, Washington, DC
  • Kyongjune Benjamin Lee, MD The George Washington University Hospital, Washington, DC
  • Bao-Ngoc Nguyen, MD The George Washington University Hospital, Washington, DC
  • Robyn Macsata, MD The George Washington University Hospital, Washington, DC
  • Shawn Sarin, MD The George Washington University Hospital, Washington, DC
  • Gregory D. Trachiotis The George Washington University Hospital, Washington, DC

DOI:

https://doi.org/10.1532/hsf.3209

Keywords:

Aortic arch dissection, Aortic arch aneurysm, Endoleak, Endovascular aneurysm repair, Fenestrated stent-graft

Abstract

Purpose: The management of patients with chronic Stanford type B aortic dissection who develop complications requires intervention without clear guidelines. Chronic aortic dissection is difficult to treat and often leads to significant morbidity and mortality. We report a complex case of chronic Stanford type B aortic dissection (TBAD) with an expanding false lumen aneurysm and distal fenestrations that required a multi-stage hybrid repair.

Technique: The patient first underwent a median sternotomy for the ascending aorta to the innominate artery and innominate artery to the left carotid artery bypass, followed by a left carotid to left axillary artery bypass. Due to continued aneurysmal growth, the patient ultimately underwent total cervical and abdominal aortic debranching as well as thoracic and abdominal endovascular grafting with iliac excluders. The patient recovered well after the surgery and had no further expansion of the aneurysm at 12-month follow up.

Conclusion: Endovascular repairs have been the mainstay of chronic TBAD repair, but hybrid approaches may be necessary for difficult repairs. A multi-stage hybrid repair approach has been successful in a patient who had a chronic type B aortic dissection with aneurysmal degeneration that failed medical management.

References

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Published

2020-09-25

How to Cite

Chen, S., Lee, K. B., Nguyen, B.-N., Macsata, R., Sarin, S., & Trachiotis, G. D. (2020). Hybrid Repair of Chronic Stanford Type B Aortic Dissection with Expanding Arch Aneurysm. The Heart Surgery Forum, 23(5), E699-E702. https://doi.org/10.1532/hsf.3209

Issue

Section

Articles