Fenestrated Thoracic Endovascular Repair for Acute Type B Aortic Dissection with Isolated Left Vertebral Artery: A Case Report

Figures

• 

  Fig. 1 Preoperative computed tomography. (A) Computed tomography on the day of admission reveals a tear in the aortic dissection at the origin of the celiac artery. (B) Computed tomography shows the shared origin of brachiocephalic and left common carotid arteries. The left vertebral artery arising directly from the aortic arch on the distal side of the left subclavian artery is indicated with an arrow. (C) Computed tomography performed on the 11th day post-admission indicates dilation of the false lumen. (D) Computed tomography performed on the day of admission and the 11th day post-admission (left to right) indicates enlargement of the descending aorta from 43 to 48 mm. (E) Computed tomography performed on the 11th day post-admission reveals an ulcer-like projection in the descending aorta. (F) Computed tomography performed on the 11th day post-admission reveals that the intramural hematoma with ulcer-like projection extended close to the left subclavian artery and isolated left vertebral artery.

• 

  Fig. 2 Angiography during endovascular repair on the 31st day after aortic dissection onset. (A) Najuta stent graft with two fenestrations is shown. Fenestrations were designed to preserve blood flow through the left subclavian and isolated left vertebral arteries. The custom-made device required a few weeks to create. Note the fact that the graft material is largely unattached to the stent thereby allowing for active seal. (B) An angiographic image shows the true lumen (white arrow), false lumen (blue arrow) and the orifice of the celiac artery tear (red arrow). (C) Angiography after implantation of the Viabahn-covered stent (yellow arrow) reveals the absence of blood flow in the false lumen and the preservation of the celiac artery circulation. (D) Angiography indicates an isolated left vertebral artery (arrowhead) arising directly from the aortic arch just distal to the left subclavian artery. (E) Angiography after implantation of Najuta stent graft indicates the preservation of the isolated left vertebral artery (arrowhead) blood flow is shown.

• 

  Fig. 3 Postoperative computed tomography. A postoperative computed tomography shows preserved isolated left vertebral artery blood flow (arrow, A); good aortic remodeling and descending aorta diameter reduction to 40 mm (B); and the absence of an ulcer-like projection in the descending aorta (C).