title: Use of the Octopus Endograft Technique to Reconstruct Renovisceral Arteries Arising From the False Lumen of a Rapidly Expanding Type B Aortic Dissection After Endovascular Repair.
abstract: To describe the use and 6-month outcomes of the octopus endograft technique to reconstruct renovisceral arteries arising from the false lumen (FL) of a type B aortic dissection after thoracic endovascular aortic repair (TEVAR).
  
  
  
  A 46-year-old man post TEVAR for type B aortic dissection was admitted with persistent back pain and a rapidly expanding residual dissection. The celiac and left renal arteries arose from the FL and the superior mesenteric artery from both lumens, with the FL as its main supply. A 20% oversized Endurant stent-graft was deployed with the short limb just above the beginning of the dissection flap and the long limb in the aortic true lumen. A 120-mm-long Endurant extended limb was delivered antegradely via a conduit and deployed into the FL, with a 3-cm overlap with the short limb of the Endurant main body. The 3 renovisceral arteries were reconstructed by lining each with a series of Viabahn or Fluency stent-grafts whose proximal ends were subsequently placed parallel in the FL Endurant extended limb and dilated with kissing balloons. Imaging at 6 months showed an excluded FL, without stenosis or occlusion in the stent-graft or the renovisceral arteries.
  
  
  
  This case illustrates the successful use of the octopus endograft technique to reconstruct renovisceral arteries arising from a rapidly expanding FL in a post-TEVAR type B aortic dissection; the technique might be applicable in carefully selected patients.
authors.affiliation: 1 Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China.
authors.forename: Jiang
authors.initials: J
authors.lastname: Xiong
authors.affiliation: 1 Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China.
authors.forename: Yangyang
authors.initials: Y
authors.lastname: Ge
authors.affiliation: 1 Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China.
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Liu
authors.affiliation: 1 Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China.
authors.forename: Lijun
authors.initials: L
authors.lastname: Wang
authors.affiliation: 1 Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Guo
mesh_terms: D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000295:instrumentation*; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D011474:Prosthesis Design; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: endograft; false lumen; octopus graft; parallel grafts; renovisceral arteries; stent-graft; stent-graft–induced new tear; thoracic endovascular aortic repair; thoracoabdominal dissection; type B aortic dissection