Abstract：Objective To evaluate feasibility of flap fenestration in management of the condition that a stent-graft is wrongly deployed in false lumen of aortic dissection. Methods A retrospective analysis was conducted on a case of Stanford type B aortic dissection who was confirmed that the stent-graft had been wrongly deployed in false lumen of aortic dissection by CT angiography (CTA) after endovascular repair. Thereafter, an additional surgical management was carried out. At length, flap fenestration at 2 cm below pre-deployed stent-graft was performed using an Outback catheter so as to link false and true lumens. Successively, another stent-graft was placed via the access to draw blood flow from false lumen back to true lumen and then coil embolization was performed for distal breach of the dissection. Results Surgery was carried out under local anesthesia, with operation duration of 170 minutes and intraoperative blood loss of 350 ml. The chest and back pain disappeared after operation. The patient commenced to take food and take off-bed activity at the very day of operation in absence of paraplegia, visceral ischemia, or other complications. Aortic CTA at postoperative one week showed ideal positioning of stent-graft, fluent blood flow of aorta and major visceral artery, and vanishing of false lumen. Conclusions Flap fenestration at far-end of pre-deployed stent-graft so as to draw blood flow back to true lumen by connecting the new placed stent graft to pre-deployed stent-graft is an effective treatment for mis-deployment of stent-graft in false lumen of aortic dissection. Outback catheter for flap fenestration is characterized by accurate location and high safety.
PAN Ye,ZHAO Jun,FU Wei-guo et al. Flap fenestration in treatment of mis-deployment of stent-graft in false lumen of aortic dissection[J]. CHINESE JOURNAL OF TRAUMA, 2013, 29(3): 216-220.
［1］Zhang R, Kofidis T, Baus S, et al. Iatrogenic type A dissection after attempted stenting of a descending aortic aneurysm. Ann Thorac Surg, 2006, 82(4):1523-1525.
［2］Panos A. Late retrograde aortic perforation by the uncovered part of an endograft: an increasing complication. Hellenic J Cardiol, 2007, 48(2):115-116.
［3］Riambau V, Guerrero F, Murillo I, et al. Stent grafting-related acute type B redissection. Vascular, 2008, 16(2):101-105.
［4］Yamashiro S, Kuniyoshi Y, Arakaki K, et al. Intraoperative retrograde type I aortic dissection in a patient with chronic type IIIb dissecting aneurysm. Interact Cardiovasc Thorac Surg, 2009, 8(2):283-236.
［5］Leontyev S, Borger MA, Legare JF, et al. Iatrogenic type A aortic dissection during cardiac procedures: early and late outcome in 48 patients. Eur J Cardiothorac Surg, 2012, 41(3) :641-646.
［8］Marty-Ané C, Serres-Cousiné O, Laborde JC, et al. Use of endovascular stents for acute aortic dissection: an experimental study. Ann Vasc Surg, 1994, 8(5):434-442.
［9］Dake MD, Miller DC, Semba CP, et al. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med, 1994, 331(26):1729-1734.
［10］Follis F, Filippone G, Stabile A, et al. Endovascular graft deployment in the false lumen of type B dissection. Interact Cardiovasc Thorac Surg, 2010, 10(4):597-599.
［11］Ugurlucan M, Alpagut U, Tireli E, et al. eComment: Advance of guidewire from the brachial artery to facilitate correct positioning of the stent graft during repair of type 3 aortic dissections. Interact Cardiovasc Thorac Surg, 2010, 10(4):599.
［12］Midulla M, Fattori R, Beregi JP, et al. Aortic dissection and malperfusion syndrome: a when, what and how-to guide. Radiol Med, 2012, Apr 1.［Epub ahead of print］.
［13］Midulla M, Renaud A, Martinelli T, et al. Endovascular fenestration in aortic dissection with acute malperfusion syndrome: immediate and late follow-up. J Thorac Cardiovasc Surg, 2011, 142(1):66-72.
［15］Patel HJ, Williams DM, Meerkov M, et al. Long-term results of percutaneous management of malperfusion in acute type B aortic dissection: implications for thoracic aortic endovascular repair. J Thorac Cardiovasc Surg, 2009, 138(2):300-308.
［16］Verhoeven EL, Paraskevas KI, Oikonomou K, et al. Fenestrated and branched stent-grafts to treat post-dissection chronic aortic aneurysms after initial treatment in the acute setting. J Endovasc Ther, 2012, 19(3):343-349.
［17］Midulla M, Renaud A, Martinelli T, et al. Endovascular fenestration in aortic dissection with acute malperfusion syndrome: immediate and late follow-up. J Thorac Cardiovasc Surg, 2011, 142(1):66-72.
