Midterm Results of Thoracic Endovascular Aortic Repair with Reentry Closure for Chronic Type B Aortic Dissection with Aneurysmal Dilatation

Figures

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  Fig. 1A Details of the reentry closure. (a) A simple Candy-Plug method is used in seven cases. (b) When the Candy-Plug is detained in the false lumen (FL) at the abdominal branch level in the true lumen. Petticoat technique with modified AFX is used in combination in three cases. Procedure of reentry closure in the abdominal branch: (c), (d), (e), (f). When the branched arteries were complete perfusions of the FL or both the FL and true lumen, we confirmed the anatomical traffic through the gastric duodenal artery between the celiac trunk and superior mesenteric artery. Spot stenting method, chimney method, and the coil embolization of the FL were performed in combination. The renal artery was used by spot stenting method. (g), (h) The intercostal artery is closed by using Excluder aortic cuff at FL side. Procedure of reentry closure in infra renal abdominal aorta: (i), (j), (k), (l). The reentry, such as lower mesenteric artery and lumber arteries, are closed using endovascular aortic repair including Double D technique. Concretely, the Endurant aortic extension (Medtronic Vascular, Santa Rosa, CA, USA) is placed from under the renal artery to the terminal abdominal aorta or the…

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  Fig. 1B A woman in her 50s after being treated with descending aorta replacement after chronic type B aortic dissection. (a), (c) Preoperative contrast enhanced computed tomography (CECT; axial and 3-dimensional) shows reentry points in the distal anastomosis, celiac trunk, lumber artery, left common iliac artery. (b), (d) CECT three years after thoracic endovascular aortic repair with reentry closure shows complete false lumen thrombosis and the reduction of false lumen area.

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  Fig. 2 (A) The change in mean false lumen (FL) area in the mean observation period of 49.2 months before and after the reentry closure. There was no statistically significant difference. (B) Kaplan–Meier analysis of survival (1) and freedom from additional intervention (2) after thoracic endovascular aortic repair with reentry closure.