PMC6722297_01
Three-dimensional computed tomography angiography after total arch replacement with the frozen elephant technique. P: posterior face, R: right side face.
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Computed tomography angiography (CTA) showed bleeding from the right subscapular artery and retrograde blood flow into the FL from multiple re-entry tears located by the visceral arteries at the level of the distal end of the FET, which were not seen earlier (Figure 1, Figure 2).
(A) Computed tomography angiography (CTA) on admission demonstrating retrograde blood flow to the level of distal end of the frozen elephant trunk (red arrow). (B) CTA at 1 month post-operatively showing complete false lumen (FL) thrombosis above the plug (red arrow). (C) Post-procedural aortography shows no blood flow into the FL above the plug (blue arrow) in C indicates the candy plug.
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Computed tomography angiography (CTA) showed bleeding from the right subscapular artery and retrograde blood flow into the FL from multiple re-entry tears located by the visceral arteries at the level of the distal end of the FET, which were not seen earlier (Figure 1, Figure 2). FL thrombosis above the plug (Figure 2, Figure 3). Furthermore, post-operative CTA showed that the stent graft in the TL was expanded satisfactorily and the FL distal the stent graft was diminishing (Fig. 4).
Serial coagulation studies on the response of fibrinogen, FDP, and platelet counts to intervention. The medical management with recombinant human rTM and TXA and transfusion. Fbg = fibrinogen; FDP = fibrin/fibrinogen degradation product; Plt = platelets; RCC = red cell concentrate; FFP = fresh frozen plasma; PC = platelet concentrate; PTE = percutaneous transcatheter embolisation; rTM = thrombomodulin; TEVAR = thoracic endovascular aortic repair; TXA = tranexamic acid.
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It was decided to perform surgical treatment because DIC findings persisted (Fig. 3). FL thrombosis above the plug (Figure 2, Figure 3). Furthermore, post-operative CTA showed that the stent graft in the TL was expanded satisfactorily and the FL distal the stent graft was diminishing (Fig. 4).
Computed tomography angiography after false lumen embolisation with the candy plug technique. The plug is indicated by a blue arrow.
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FL thrombosis above the plug (Figure 2, Figure 3). Furthermore, post-operative CTA showed that the stent graft in the TL was expanded satisfactorily and the FL distal the stent graft was diminishing (Fig. 4).