Management and follow-up of patient with circumferential type B aortic dissection using GORE thoracic-branch endograft

Type B aortic dissection with high-risk features such as a large entry tear, false lumen, and circumferential dissection has a greater chance of progression and rupture without definitive surgical intervention. Traditional thoracic endovascular aortic repair of dissection with proximal zone 1 landing requires extensive aortic arch debranching to minimize the risk of ischemic stroke with endograft deployment. Recent developments in endovascular grafts for thoracic endovascular aortic repair have allowed for an optimized approach in challenging cases. We present the case of a 53-year-old male with circumferential type B aortic dissection and higher-risk features treated with a staged right-to-left carotid bypass and subsequent thoracic endovascular aortic repair with a GORE^Ⓡ TAG^Ⓡ Thoracic Branch Endoprosthesis for zone 1 proximal landing.