New approach to type B aortic dissection – zone 2.5 thoracic endovascular aortic repair: a case report

Figures

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  Fig. 1. Preoperative contrast-enhanced computed tomography (CT) images. (A, B) Axial and sagittal views at the aortic arch level show the primary entry tear (black arrows) located just distal to the origin of the left subclavian artery (LSA). (C, D) Axial and coronal views at the level of the iliac bifurcation demonstrate collapse of the left common iliac artery (arrows) due to compression of the true lumen by the false lumen

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  Fig. 2. Intraoperative angiography during thoracic endovascular aortic repair (TEVAR). (A) Initial aortogram shows the primary entry tear (black arrow) located just distal to the origin of the LSA. True (T) and false (F) lumens are indicated. (B) Completion angiography after stent-graft deployment demonstrates that the proximal edge of the stent graft is positioned slightly within the LSA lumen, achieving a stable proximal seal (Zone 2.5 landing) with preserved LSA perfusion. (C–E) Sequential angiographic views during deployment. (C) Aortogram obtained immediately before stent-graft deployment. (D) The greater-curvature portion of the proximal stent approaches the LSA orifice, and (E) the greater-curvature edge of the stent graft enters the LSA lumen (arrow), serving as a practical landmark for achieving the intended Zone 2.5 landing. The white tracing line outlines the aortic contour to clarify the spatial relationship between the aorta and the stent graft

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  Fig. 3. Postoperative contrast-enhanced computed tomography (CT) images after TEVAR. (A) CT obtained 4 days postoperatively shows complete exclusion of the primary entry tear and thrombosis of the false lumen in the thoracic aorta. (B) CT at 1 year follow-up demonstrates sustained false lumen thrombosis and favorable aortic remodeling with preserved LSA perfusion