Thoracic endovascular aortic repair using a Najuta thoracic fenestrated stent graft for type B aortic dissection with an aberrant right subclavian artery

Abstract

An aberrant right subclavian artery (ARSA) is a rare vascular malformation, and the surgical treatment of aortic diseases in patients with ARSA often necessitates the use of specialized techniques depending on the location of its orifice. Herein, we report a case of chronic Stanford type B aortic dissection (TBAD) with ARSA and false lumen perfusion of the abdominal branches; entry tear closure was achieved through thoracic endovascular aortic repair (TEVAR) using a fenestrated stent graft while preserving false lumen perfusion. The patient was a 48-year-old man with a 3-year history of acute TBAD with ARSA. Outpatient computed tomography revealed dissecting aortic aneurysm enlargement (>5 mm) over 6 months. As the celiac and superior mesenteric arteries were supplied by the false lumen and only small re-entry tears were identified in the bilateral external iliac arteries, the risk of intestinal ischemia due to stent-graft closure of the entry tear was recognized. To preserve false lumen perfusion, a new re-entry tear was created using a guidewire and percutaneous transluminal angioplasty balloon catheter under intravascular ultrasound guidance, followed by debranching TEVAR with a Najuta thoracic fenestrated stent graft (Kawasumi Laboratories, Inc., Tokyo, Japan). The patient had an uneventful postoperative course and was discharged on postoperative day 10.

Learning objective

Entry tear closure with thoracic endovascular aortic repair for type B aortic dissection with an aberrant right subclavian artery often requires complex cervical debranching; however, the use of a Najuta thoracic fenestrated stent graft may simplify the surgical procedure. If the abdominal branches are perfused by the false lumen and the re-entry tear is small, the creation of a new re-entry tear using a guidewire and percutaneous transluminal angioplasty balloon catheter under intravascular ultrasound guidance is a practical approach for preserving false lumen blood flow.