PMC6719283_01
Pre-operative computed tomography scan showing type IV thoraco-abdominal aneurysm with dilatation of both iliac axis.
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The TAA had a maximum diameter of 37 mm in the descending thoracic aorta and 73 mm at the level of visceral trunks, with involvement of both iliac arteries, reaching 30 mm in the left common iliac artery (Fig. 1).
Intraprocedural angiogram showing fenestrated endovascular aneurysm repair with four fenestrations + left iliac branch (A). 3D reconstruction (B) and maximum intensity projection (MIP) (C) of the 24 hour post-operative computed tomography scan showing correct placement of all the components and patency of all visceral branches.
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An iliac branch endograft (Zenith Iliac Branch, Cook Medical, Bloomington, IN, USA) was also implanted in the left iliac axis (Fig. 2A). In the computed tomography (CT) scan done before discharge, correct placement of all the components and patency of all visceral branches was observed (Fig. 2B and C).
Computed tomography scan 30 days after the initial procedure showing patency of all visceral branches and iliac branch device without endoleaks.
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In the one month follow up CT scan, the correct positioning of the endoprostheses was verified, with patency of all of the visceral branches (Fig. 3).
Computed tomography scan showing type B aortic dissection beginning just after the origin of the left subclavian artery and extending to the proximal stent of the fenestrated endograft.
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The dissection extended to the proximal stent of the fenestrated endograft, without perfusion of the sac (Fig. 4), with a maximum diameter of the affected aorta of 44 mm and a maximum diameter of the false lumen of 17 mm, almost completely collapsing the true lumen near the thoraco-abdominal transition.
Intraprocedural angiogram during thoracic endovascular aortic repair (A) and MIP (B), and 3D reconstruction (C) computed tomography scan after the procedure.
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These were placed just distal to the left subclavian artery origin, which remained patent, to close to 20 mm above the coeliac trunk stent, obtaining complete sealing of the dissection and with no evidence of endoleaks on the final angiogram (Fig. 5A) or on the CT scan (Fig. 5B and C). The post-operative period was complicated by respiratory infection, persistent fever, and pleural effusion, but the patient left the hospital one month after the procedure requiring only adequate family support at home.
Computed tomography scan two years after thoracic endovascular aortic repair (TEVAR). All TEVAR, fenestrated endovascular aneurysm repair, iliac branch device, and visceral vessels are patent. No endoleaks were noted, and there was complete remodelling of false lumen.
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No endoleaks were noted, and complete remodelling of the false lumen had been achieved (Fig. 6).