Hybrid Repair of Chronic Stanford Type B Aortic Dissection with Expanding Arch Aneurysm
Keywords:Aortic arch dissection, Aortic arch aneurysm, Endoleak, Endovascular aneurysm repair, Fenestrated stent-graft
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.
Diethrich EB, Ramaiah VG, Kpodonu J, et al. 2008. Case 16: Endovascular Management of Acute Stanford Type B Dissection. Endovascular and Hybrid Management of the Thoracic Aorta: A Case-based Approach. Blackwell Publishing Ltd., Hoboken, NJ. 104–113.
Fattori R, Cao P, De Rango P, et al. 2013. Interdisciplinary expert consensus document on management of type B aortic dissection. Journal of the American College of Cardiology. Apr 23;61(16):1661-1678.
Hagan PG, Nienaber CA, Isselbacher EM, et al. 2000. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 283(7): 897-903.
Hiratzka LF, Bakris GL, Beckman JA, et al. 2010. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, A. Journal of the American College of Cardiology. 55(14):e27–129.
Kang WC, Greenberg RK, Mastracci TM, et al. 2011. Endovascular repair of complicated chronic distal aortic dissections: intermediate outcomes and complications. Journal of thoracic and cardiovascular surgery. 142(5):1074-83.
Nauta FJ, Trimarchi S, Kamman AV, et al. 2016. Update in the management of type B aortic dissection. Vascular Medicine. 21(3): 251-63.
Roselli EE. 2015. Thoracic endovascular aortic repair versus open surgery for type-B chronic dissection. Journal of Thoracic and Cardiovascular Surgery. 149(2):S163-7.
Svensson LG, Kouchoukos NT, Miller DC, et al. 2008. Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. The Annals of thoracic surgery. 85(1):S1-41.
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