PMC7287399_01
(A) Pre-operative enhanced computed tomography (CT) showing thrombosed type B dissection and abdominal dissected aneurysm. (B) The false lumen at pulmonary artery level is thrombosed. (C) Enhanced CT scan showing a re-entry point at the base of the left renal artery. (D) Enhanced CT scan showing a 47 mm diameter abdominal dissected aneurysm with re-entry in the abdominal aorta.
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However, the false lumen of the infrarenal abdominal aorta including the aneurysmal part, remained patent owing to entry sites in the abdominal aorta, external iliac arteries, and a LRA membrane tear (Fig. 1A-D).
Intra-procedural findings. (A) The re-entry in the abdominal aorta is closed using iliac extensions (Medtronic, Minneapolis, MN, USA) and an aortic extender (WL Gore and Associates). Embolisation of the inferior mesenteric artery is performed using the Amplatzer Vascular Plug 4 (St. Jude Medical, Plymouth, MN, USA). (B) The left renal artery originates from the false lumen. (C) The Viabahn endoprosthesis (WL Gore and Associates) occludes the re-entry of the left renal artery with preserved renal blood flow. (D) Perfusion of the right internal iliac artery is preserved using the sandwich technique with two Viabahn endoprostheses. (E) Completion angiography in the early phase confirms absence of type Ia endoleak and any residual re-entry of the abdominal aorta and left renal artery. (F) Completion angiography in the late phase demonstrates a slightly patent false lumen via the right common iliac artery following the incomplete sandwich technique.
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Gore and Associates) were deployed to seal the entry site within the abdominal aorta (Fig. 2A). Gore and Associates) were inserted through the left brachial artery and deployed to extend from the abdominal aorta membrane tear to the entry site of the LRA, with preservation of a branch of the renal artery (Fig. 2B and C). Additionally, another Viabahn endoprosthesis (11 x 50 mm; W.L. Gore and Associates) was deployed to the left external iliac artery to seal its re-entry site. Gore and Associates) (Fig. 2D). Completion angiography showed a slightly patent false lumen via the right common iliac artery following the incomplete sandwich technique (Fig. 2E and F).
(A) Follow up computed tomography (CT) angiography three months post-operatively confirming patency of the left renal artery. (B) Enhanced CT confirming complete remodelling of the dissected false lumen of the descending aorta. (C) Enhanced CT confirming absence of endoleak and demonstrating complete thrombosis and shrinkage of the abdominal dissected aneurysm sac.
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Follow up imaging confirmed absence of endoleak, AAA sac shrinkage, and remodelling of the dissected aorta (Fig. 3A-C).