Lobato technique for acute type B aortic dissection complicated by thoracoabdominal aortic aneurysm and total true lumen occlusion of the infrarenal aorta

Figures

• 

  Fig 1. Computed tomography angiography (CTA) images. A, Entry tear located at the level of the ninth thoracic vertebra with an abdominal aorta maximum diameter of 57 mm × 52 mm. B, Celiac trunk (CT) emerging from the true lumen (TL) with an aorta maximum diameter of 50 mm × 45 mm. C, Superior mesenteric artery (SMA) emerging from the TL with an aorta maximum diameter of 59 mm × 50 mm. D, Left renal artery (LRA) emerging from the TL with an aorta maximum diameter 57 mm × 53 mm. E, Right renal artery (RRA) emerging from the TL with an aorta maximum diameter of 53 mm × 40 mm. F, No blood flow in the TL of the abdominal aorta and common iliac arteries was observed owing to collapse of the TL resulting from expansion of the false lumen (FL). G, FL extending from the abdominal aorta to the left common iliac artery (LCIA). H, The TL only reopened in a distal segment of the right common iliac artery (RCIA) owing to back flow from the right internal iliac artery (RIIA). I, Origin of the left internal iliac artery (LIIA) was occluded by FL compression. J, FL extending to mid-segment of the left external iliac artery (LEIA). K, TL running alone only in the distal part of LEIA. L, Preoperative CTA…

• 

  Fig 2. Stepwise and fully illustrated description of the Lobato technique (LT) for acute type B aortic dissection (TBAD) complicated by a thoracoabdominal aortic aneurysm (TAAA) and total true lumen (TL) occlusion of the infrarenal aorta. A, Surgical exposure and cannulation of the left common femoral and subclavian arteries after systemic heparinization. B, A standard 0.035-in. guidewire with a hydrophilic coating (Radifocus; Terumo, Tokyo, Japan) was successfully advanced from the left subclavian artery to the distal segment of the left external iliac artery to be snared by an Amplatz goose neck snare catheter (Medtronic, Minneapolis, MN) inserted from the left femoral artery using the through-and-through guidewire technique. A second standard 0.035-in. guidewire with a hydrophilic coating (Radifocus) was successfully inserted from the right subclavian artery to the TL, located at the distal segment of the abdominal aorta, and subsequently exchanged with a super-stiff 0.035-in. guidewire (Amplatz; Boston Scientific, Natick, MA). C, A Valiant thoracic stent graft with the Captivia delivery system (Medtronic Vascular, Santa Rosa, CA; diameter, 26-26 mm; length, 150 mm) was inserted from…

• 

  Fig 3. Preoperative and 34-month follow-up computed tomography angiography (CTA) for comparison showing very positive aortic remodeling (false lumen reduction in maximal diameter; true lumen [TL] expansion in maximal diameter; no growth in total aortic diameter; and total aortic maximal diameter reduction). A, Preoperative CTA demonstrating a large-diameter thoracic aortic aneurysm and a patent false lumen. B, Postoperative CTA highlighting shrinkage of the aneurysm sac with no endoleak formation. C, Three-dimensional multiplanar reconstruction CTA demonstrating preservation of the visceral circulation. D, Three-dimensional multiplanar reconstruction CTA highlighting a patent femorofemoral crossover bypass performed to preserve circulation to the lower limbs.