title: Transcarotid artery endovascular reconstruction of the aortic arch by modified bifurcated stent graft for Stanford type A dissection.
abstract: A 40-year-old man with Stanford type B dissection underwent his first endovascular repair (EVAR) in April 2004 by Talent thoracic stent graft. He had an uncomplicated recovery and maintained good blood pressure control. However, a new retrograde dissection appeared in September 2004. The new dissection involved his aortic arch and ascending thoracic aorta to the opening of the coronary arteries. To reconstruct the aortic arch, bypasses between the right common carotid artery (RCCA), left common carotid artery and left subclavian artery were performed before endovascular repair. A modified bifurcated Talent stent graft was deployed from the RCCA to the ascending thoracic aorta with a long limb in the innominate artery and a short limb in the aortic arch. A further two pieces of graft were deployed via the common femoral artery. The ascending thoracic aorta and aortic arch were reconstructed completely by the bifurcated stent graft. The final angiography confirmed that there was good stent graft configuration, normal blood flow, and stable haemodynamics. No endoleak or other major complications were encountered. This result indicated that it is possible to reconstruct the aortic arch with a bifurcated stent graft and could be a new endovascular repair model for complex thoracic aortic aneurysm and dissection.
authors.affiliation: Department of Vascular Surgery, The General Hospital of the PLA, Beijing, China. pla301dml@vip.sina.com
authors.forename: Wei
authors.initials: W
authors.lastname: Guo
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Liu
authors.forename: Faqi
authors.initials: F
authors.lastname: Liang
authors.forename: Daihua
authors.initials: D
authors.lastname: Yang
authors.forename: Guohua
authors.initials: G
authors.lastname: Zhang
authors.forename: Li
authors.initials: L
authors.lastname: Sun
authors.forename: Qin
authors.initials: Q
authors.lastname: Song
authors.forename: Shaohong
authors.initials: S
authors.lastname: Zhao
authors.forename: Luyue
authors.initials: L
authors.lastname: Gai
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D015901:Angiography, Digital Subtraction; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures; D015607:Stents; D014057:Tomography, X-Ray Computed