Endovascular laser fenestration of a frozen elephant trunk stent graft for treatment of chronic cerebral malperfusion.

IF 0.9 4区医学 Q4 PERIPHERAL VASCULAR DISEASE Vascular Pub Date : 2025-01-09 DOI:10.1177/17085381251313581

Richard Shi, Sanford Manning Zeigler, Mathew David Wooster

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Abstract

Objectives: Mal-deployment of the thoracic endovascular aortic repair (TEVAR) stent graft during a frozen elephant trunk (FET) procedure for an acute type A aortic dissection (ATAAD) leads to devastating complications. We report a hemiarch replacement with TEVAR stent graft covering the aortic arch vessels salvaged through an endovascular approach.

Methods: A 69-year-old man with ATAAD in 2018, status post-hemiarch repair with TEVAR, presented in 2023 with progressive dizziness/syncope and lower extremity hypertension with inability to tolerate anti-hypertensives. A CT scan revealed TEVAR stent graft coverage of the brachiocephalic, left common carotid (LCA), and left subclavian artery (LSA), with retrograde flow into the arch vessels through a false lumen fed by a dissection fenestration at the aortic bifurcation. Given an elevated peri-operative death and stroke risk with an open arch revision, we performed an in situ anterograde laser fenestration of his FET with LCA and LSA stenting via the Culotte technique.

Results: On 1 year follow-up, the patient's dizziness has resolved, and he has maintained normotension via anti-hypertensives.

Conclusion: Laser fenestration and the Culotte technique can be used to salvage a TEVAR causing coverage of the arch vessels, showing that endovascular techniques can be a safe alternative for rescuing mal-positioned FETs.

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冷冻象鼻支架血管内激光开窗治疗慢性脑灌注不良。

目的：在治疗急性a型主动脉夹层（ATAAD）的冷冻象鼻（FET）手术中，胸椎血管内主动脉修复（TEVAR）支架的错误部署导致了毁灭性的并发症。我们报告一例经血管内入路修复的覆盖主动脉弓血管的TEVAR支架充血置换。方法：一名69岁男性，2018年患有ATAAD，采用TEVAR进行出血后修复，于2023年出现进行性头晕/晕厥和下肢高血压，无法耐受抗高血压药物。CT扫描显示TEVAR支架覆盖了头臂、左颈总动脉（LCA）和左锁骨下动脉（LSA），血流通过主动脉分叉处夹层开窗的假腔逆行进入弓血管。考虑到开放弓翻修术的围手术期死亡和卒中风险升高，我们通过Culotte技术对他的FET进行了原位顺行激光开窗，并进行了LCA和LSA支架置入。结果：随访1年，患者头晕症状消失，并通过降压药维持血压正常。结论：激光开窗和Culotte技术可用于挽救导致弓血管覆盖的TEVAR，表明血管内技术可作为一种安全的替代方法来挽救定位错误的fet。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Vascular 医学-外周血管病

CiteScore

2.30

自引率

9.10%

发文量

196

审稿时长

6-12 weeks

期刊介绍： Vascular provides readers with new and unusual up-to-date articles and case reports focusing on vascular and endovascular topics. It is a highly international forum for the discussion and debate of all aspects of this distinct surgical specialty. It also features opinion pieces, literature reviews and controversial issues presented from various points of view.