PMC5678882_01
Findings of pre-operative computed tomography. (A) Axial view. Yellow arrows show the false aneurysm at the distal anastomosis. Maximum diameter is 53 mm. (B) Sagittal view. The distance between the anastomosis and the bottom of the fenestrated flap is 19 mm. (C) Small re-entry near the origin of the right renal artery.
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Pre-operative computed tomography (CT) showed an anastomotic false aneurysm at the distal site (Fig. 1A). The distance between the aneurysm and the bottom of the fenestrated flap was 19 mm (Fig. 1B). A small re-entry existed near the origin of the right renal artery (Fig. 1C).
(A) Intra-operative findings of "intimal flap septostomy". Yellow arrow shows inflated cutting balloon over the intimal flap. (B) Schema of the present technique. (C) Post-operative computed tomography shows a sufficient distal landing zone for the thoracic stent graft. The distance between the anastomosis and the bottom of the fenestrated flap is increased to 52 mm (compared with Fig. 1B).
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Monorail (Boston Scientific, Marlborough, MA, USA) was advanced to the fenestrated flap (Fig. 2A). Moving the guidewire and the balloon like a wire saw (Fig. 2B), the flap was gently incised distally about 3.5 cm. The distance between the anastomosis and the bottom of the fenestrated flap was 5.2 cm (Fig. 2C).