Endovascular repairs of complex chronic post-dissection thoracoabdominal aortic aneurysm using modular patient-specific fenestrated-branched stent-graft components.

Abstract

Chronic post-dissection thoracoabdominal aortic aneurysms (pD-TAAAs) pose unique challenges for endovascular repair due to true lumen compression, vessel origin from separate lumens, and extension of dissection into side branches. We report two cases of pD-TAAA with persistent false lumen perfusion and progressive aortic dilatation. In both cases, the celiac axis was perfused from an isolated false lumen due to occlusion of the reentrance tear, with the remaining patent target vessels originating from the true lumen. The first case is a 74-year-old man with chronic extent-III TAAA with a prior type-B3,9 acute dissection. The second case is a 68-year-old man with a chronic extent-II TAAA with a prior type-A0-9 acute dissection. Both patients underwent patient-specific fenestrated-branched endovascular aortic repair using a proximal branched-stent-graft and a distal fenestrated-stent-graft. Two-component modular stent-grafts provide an additional therapeutic option for complex post-dissection aneurysms involving visceral vessels, encompassing both true and false lumens.