The arch and beyond: bare stents in the ascending aorta.
OBJECTIVE
To describe the management of complications from an unsuccessful hybrid repair of an aortic arch aneurysm.


METHODS
A 63-year-old man with acute type B dissection and retrograde dissection into the aortic arch underwent emergent hybrid repair, with partial debranching (ascending aorta to left carotid artery bypass) and proximal stent-graft deployment. At 3 months, computed tomography (CT) showed stent-graft migration, causing a large type I endoleak; flow through the patent left subclavian artery (LSA) caused a large type II endoleak. At a second operation, a bilateral subclavian-to-carotid transposition was performed; the LSA was ligated and a Zenith TX2 thoracic endograft was deployed to seal the leak. Recurrent type I endoleak a year later prompted the final endovascular solution: total supra-aortic vessel debranching, proximal stent-graft deployment, and the unprecedented use of bare Z stents in the ascending aorta. CT at 18 months confirmed stable stent-graft position and no endoleak.


CONCLUSIONS
Based on this initial experience, bare Z stents can be used to enhance proximal aortic stent-graft fixation and accommodation within the aortic arch.
Ferreira
Marcelo
M
SITE - Serviço Integrado de Técnicas Endovasculares, Rio de Janeiro, Brazil. marceloferreira@siteendovascular.com
Lanziotti
Luiz
L
Monteiro
Marcelo
M
Abuhadba
Giafar
G
D000784:Aortic Dissection / Q000601:surgery*; D017130:Angioplasty; D001014:Aortic Aneurysm / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D004867:Equipment Design; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents