PMC8077236_01
Colour illustration and three dimensional computed tomography angiography reconstruction of an extent II post-dissection thoraco-abdominal aortic aneurysm status post-total arch repair with elephant trunk. (A) Stage 1 repair with thoracic stent grafting from the elephant trunk to the level of the coeliac axis with two tapered Zenith Alpha endografts. (B) Illustration of balloon dilation of a small re-entry at the level of the right renal artery by inflating a Coda balloon in the true lumen, and using a re-entry catheter from the false lumen to puncture the septum and Coda balloon to establish wire access across the septum. (C) A Coda balloon was used to dilate the re-entry and facilitate future incorporation of the right renal artery. (D) Illustration of compression of the true lumen by a pressurised false lumen, below the level of the dilated re-entry. (E) Illustration of sequential catheterisation of the four target vessels from the upper extremity approach. (F) Illustration and three dimensional reconstruction of the completed four vessel fenestrated repair using (G) a physician modified Zenith Alpha thoracic stent graft
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The left renal and mesenteric vessels were perfused by the true lumen (Fig. 1A and B). This was performed using intravascular ultrasound (IVUS) and a re-entry catheter to access the false lumen, followed by balloon angioplasty with a partially inflated 32 mm Coda balloon (Fig. 1C and D). CTA revealed compression of the true lumen in the infrarenal aorta by the pressurised false lumen from the new fenestration (Fig. 1E).