Complex zone 0 aortic arch repair using TBE device: Case report and literature review

Introduction

The thoracic branch endoprosthesis (TBE) is intended for the treatment of proximal descending aortic pathology with preservation of the left subclavian artery blood flow. For the treatment of more extensive pathologies comprising the aortic arch, current devices are limited. We present a case and literature review regarding use of TBE device in a proximal (Zone 0) aortic aneurysm repair.

Case report

A 59-year-old male patient with a history of ascending aortic open repair due to a type A dissection presented with an enlarging proximal descending aorta. Due to refusal for further open aortic surgical intervention, a two-staged hybrid repair was performed comprising extra-anatomic bypasses followed by zone 0 TBE repair. Complications related to surgical intervention; but, not to the aortic arch repair included anaphylactic reactions that required rescheduling of surgical procedure. Postoperative follow-up demonstrated a successful repair with patent stent grafts and bypasses.

Discussion

TBEs are part of the emerging technologies for the treatment of aortic arch pathologies. This case highlights the use of the device in a patient with complex aortic dissection enlargement secondary to a previously emergent surgical management of a type A aortic dissection. The literature review highlights the emerging use of endovascular technologies and its pitfalls as the risk of stroke and endoleak in the short- and long-term are not insignificant.

Conclusion

Despite its off-label use, TBEs can be effective and a feasible solution in patients who either refuse or do not qualify for open aortic surgical intervention. However, close follow-up is necessary, as short- and long-term studies suggest a significant rate of stroke and endoleaks.