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Endovascular Aortic Arch Repair after Previous Open Ascending Aortic Reconstruction
Adam W. Beck
UAB, Birmingham, AL
Aortic reintervention in patients who have undergone ascending aortic repair for an Acute Type-A represents technical and physiologic challenges from open, hybrid and endovascular perspectives. Often this patient population has anatomically disadvantageous re-entry tears in the Arch and Descending Aorta leading to false lumen aneurysmal degeneration. This case demonstrates an endovascular repair with an investigational device for the Aortic Arch landing proximally in Zone 0 and distally in a tortuous chronically dissected and aneurysmal thoracic aorta extending into the visceral segment. The patient is a 63-year-old woman with a history of lung cancer in long-standing remission, who suffered a Type A dissection 4 years prior when the ascending aorta was replaced with a surgical graft from the sinotubular junction to just proximal to the innominate artery. The remainder of aorta was native with a dissection extending into the infrarenal aorta. The primary septal tear feeding the false lumen was located at the distal anastomosis of the ascending surgical repair adjacent to the innominate artery. The endovascular arch repair was performed in two stages with a cervical debranching 2 days prior to the index endovascular arch repair, which was performed without incident. Post-operatively the patient did well without complications and was discharged to home 48 hours after the arch repair. The patient was doing well at 24-month follow-up with remodeling throughout the arch/descending thoracic aorta, including the aorta distal to the device. The patient is now in ongoing routine follow-up.
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