Thoracic endovascular aortic repair (TEVAR) and the frozen elephant trunk (FET) are well-established treatment options for aortic dissection (AD). Inadvertent misdeployment of a TEVAR stent graft or FET into the false lumen (FL) can lead to serious complications. We report two cases of FL misdeployment. First, a 68-year-old female with acute Stanford type B AD underwent TEVAR; follow-up computed tomography angiography (CTA) revealed stent-graft misdeployment into the FL. Second, a 44-year-old female with Marfan syndrome, who had undergone supracoronary ascending aortic grafting for type A AD at 25 years of age, underwent urgent FET 19 years later for a symptomatic dissecting arch aneurysm; follow-up CTA confirmed misdeployment into the FL. In both cases, endovascular rescue was performed with fenestration of the intimal flap and additional stent-graft deployment to reroute flow into the true lumen. Misdeployment of TEVAR or FET into the FL is catastrophic but treatable with rapid diagnosis and timely intervention.
Hudák et al. (Fri,) studied this question.