New Advances in Endovascular Therapy: Endovascular Repair of a Chronic DeBakey Type II Aortic Dissection With a Scalloped Stent-Graft Designed for the Ascending Aorta

J Endovasc Ther. 2016 Feb;23(1):182-5. doi: 10.1177/1526602815621063. Epub 2015 Dec 14.

Abstract

Purpose: To describe the deployment into the ascending aorta of a fenestrated stent-graft with a scallop for the innominate artery.

Technique: A 72-year-old multimorbid patient presented with a chronic DeBakey type II aortic dissection of the ventral ascending aorta with close proximity (16 mm) to the innominate artery. A 1-piece, 46-mm-diameter Zenith Ascend Thoracic Endovascular Graft with circumferential diameter-reducing sutures (ProForm) was custom made with a 15×30-mm scallop for the innominate artery. The stent-graft was loaded on a Z-Trak Plus Introducer System with a 20-F hydrophilic-coated sheath and successfully implanted under inflow occlusion in a procedure that lasted 35 minutes.

Conclusion: The use of fenestrated stent-grafts in the ascending aorta is feasible, and a scallop in the distal stent-graft can extend coverage of the ascending aorta in pathologies close to the innominate artery. This technique broadens the range of endovascular options for patients not suitable for open surgery.

Keywords: aortic dissection; ascending aorta; fenestrated stent-graft; innominate artery; scalloped stent-graft; thoracic endovascular aortic repair; type B dissection.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Aorta, Thoracic / diagnostic imaging
  • Aorta, Thoracic / surgery*
  • Aortic Aneurysm, Thoracic / diagnosis
  • Aortic Aneurysm, Thoracic / surgery*
  • Aortic Dissection / diagnosis
  • Aortic Dissection / surgery*
  • Aortography / methods
  • Blood Vessel Prosthesis Implantation / instrumentation*
  • Blood Vessel Prosthesis*
  • Brachiocephalic Trunk / diagnostic imaging
  • Brachiocephalic Trunk / surgery*
  • Chronic Disease
  • Endovascular Procedures / instrumentation*
  • Humans
  • Male
  • Prosthesis Design
  • Stents*
  • Suture Techniques
  • Tomography, X-Ray Computed
  • Treatment Outcome