PMC4602650_01
(A) Volume rendering of the residual type A dissection; (B) Najuta endograft; (C) precurved shape of the Najuta endograft; (D) reconstruction of the final angiography control.
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F1
The celiac trunk and the superior mesenteric and right renal arteries were perfused by the true lumen; the left renal artery was perfused by the false lumen (Figure 1A). It has a precurved shape, which is critical for enhancing the stability of the endograft in the aortic arch (Figure 1C). The final angiography confirmed the proper positioning of the device and the absence of endoleaks, the exclusion of the proximal entry tear, and the patency of the brachiocephalic artery and the left carotid artery (Figure 1D); also the celiac trunk and the superior mesenteric and right renal arteries were well perfused by the true lumen; the left renal artery was perfused by the false lumen via the fenestration at the abdominal level.
(A) Angio-CT documenting the proximal infolding of the endograft and the left common carotid dissection; (B) angioplasty of the proximal infolding and retrograde angiography of the dissected left common carotid; (C) angio-CT documenting the residual proximal leak and no residual dissection of the left common carotid. CT = computed tomography.
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F2
The angio-CT showed also an asymptomatic proximal infolding of the endograft causing a type 1A endoleak (Figure 2A). At that time we did not have disponibility of an adequate aortic stent; therefore, the proximal infolding of the endograft was treated by simple angioplasty inflating a Coda Balloon 40 mm (Cook Incorporated) (Figure 2B). The procedure was successful and the patient did not experience further TIA, but the angio-CT control revealed a residual proximal leak (Figure 2C).
(A) Angio-CT documenting the evolution of the proximal infolding; (B) angio-CT documenting the resolution of the proximal infolding by the well-expanded Jotec stent; (C) final volume rendering of the arch; (D) final volume rendering of the aorta. CT = computed tomography.
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F3
We introduced and released an aortic stent, Jotec "double flared" 32 to 70 mm (Hechingen, Germany), at the proximal landing zone (Figure 3A) of the Najuta endograft. Final angio-CT, performed 1 month later, documented the good position of all the endografts and no residual infolding (Figure 3B-D).