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Transapical endovascular repair of iatrogenic type A aortic dissection

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1 Transapical endovascular repair of iatrogenic type A aortic dissection
Sangmin Kim, MD, Cristobal Ducaud, BS, Raul E. Herrera, MD, Nibert Moreno, MD, Juan C. Zevallos, MD, Barry T. Katzen, MD  Journal of Vascular Surgery Cases and Innovative Techniques  Volume 4, Issue 3, Pages (September 2018) DOI: /j.jvscit Copyright © 2018 The Authors Terms and Conditions

2 Fig 1 A-F, Computed tomography (CT) showed type A aortic dissection (arrows) arising from the sinotubular junction and extending through the aortic bifurcation into the left common iliac artery (LCIA). F, The left kidney was supplied by both the false and true lumens (*). There was no evidence of associated renal infarct. Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, DOI: ( /j.jvscit ) Copyright © 2018 The Authors Terms and Conditions

3 Fig 2 Transapical thoracic endovascular aortic repair (TaTEVAR) and sequential angioplasty of the left renal artery (LRA), distal aorta, and inferior mesenteric artery (IMA) were performed successfully. A-F, Successful placement of two Gore Excluder cuffs within the proximal thoracic aorta (TA) through a transapical approach to exclude a proximal fenestration between the true and false lumens. G, Placement of an LRA stent at the ostium. H, Deployment of two Atrium (Maquet) stents within the infrarenal abdominal aorta (AA) after coil embolization of the IMA. I, A small amount of contrast material is visualized within the false lumen that does not extend along the length of the true lumen. Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, DOI: ( /j.jvscit ) Copyright © 2018 The Authors Terms and Conditions

4 Fig 3 Post-transapical thoracic endovascular aortic repair (TaTEVAR) follow-up computed tomography (CT) findings. A, Demonstration of TaTEVAR of a type A dissection with patent coronary arteries and no significant interval change in location of the Gore Excluder cuffs. B-G, Persistent opacification (arrow) of the abdominal portion of the false lumen beginning at the level of the superior mesenteric artery and extending inferiorly adjacent to the infrarenal abdominal aortic stents. F, The dissection extends into the common iliac artery on the left side without significant interval change compared with preprocedure imaging. B and G, Widely patent renal arteries bilaterally including a stent within the proximal aspect of the left renal artery (LRA) extending from the true lumen into the renal artery. Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, DOI: ( /j.jvscit ) Copyright © 2018 The Authors Terms and Conditions

5 Fig 4 Most recent follow-up computed tomography (CT) findings on November 5, A-E, No significant residual dissection present. C, D, and E, Resolution of the false lumen opacification seen on previous examinations within the abdominal portion of the dissection. B, D, and E, Patent left renal artery (LRA) stent. Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, DOI: ( /j.jvscit ) Copyright © 2018 The Authors Terms and Conditions

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