Flap fenestration in treatment of mis-deployment of stent-graft in false lumen of aortic dissection

Objective To evaluate feasibility of flap fenestration in management of the condition that a stentgraft is wrongly deployed in false lumen of aortic dissection. Methods A retrospective analysis was conducted on a case of Stanford type B aortic dissection who was confirmed that the stentgraft had been wrongly deployed in false lumen of aortic dissection by CT angiography （CTA） after endovascu lar repair. Thereafter, an additional surgical management was carried out. At length, flap fenestration at 2 cm below predeployed stentgraft was performed using an Outback catheter so as to link false and true lumens. Successively, another stentgraft was placed via the access to draw blood flow from false lumen back to true lumen and then coil embolization was performed for distal breach of the dissection. Results Surgery was carried out under local anesthesia, with operation duration of 170 minutes and intraoperative blood loss of 350 ml. The chest and back pain disappeared after operation. The patient commenced to take food and take offbed activity at the very day of operation in absence of paraplegia, visceral ischemia, or other complications. Aortic CTA at postoperative one week showed ideal positioning of stentgraft, flu ent blood flow of aorta and major visceral artery, and vanishing of false lumen. Conclusions Flap fen estration at farend of predeployed stentgraft so as to draw blood flow back to true lumen by connecting the new placed stent graft to predeployed stentgraft is an effective treatment for misdeployment of stent graft in false lumen of aortic dissection. Outback catheter for flap fenestration is characterized by accurate location and high safety.