Treatment of Stanford type A aortic dissection with triple prefenestration, reduced diameter, and three-dimensional-printing techniques: A case report

BACKGROUND A 63-year-old female was diagnosed with acute Stanford type A aortic dissection.The patient had pain in the chest and back for 1 wk.The computed tomography angiography(CTA)showed Stanford type A aortic dissection(Myla type III aortic arch).The intimal tear was located at the top of the aortic arch and retrograded to the ascending aorta.CASE SUMMARY Preoperatively,a three-dimensional(3D)-printed model of the aortic arch was made according to CTA data.Then,under the guidance of the 3D-printed aortic model,a pre-fenestrated stent-graft was customized,and the diameter of the stent-graft was reduced intraoperatively by surgeons.3D printing,triple prefenestration,and reduced diameter techniques were used during the surgery.The CTA examinations were performed at the 3rd mo and 1st year after the surgery;the results showed that the aortic dissection was repaired without endoleak,and all three branches of the aortic arch remained unobstructed.CONCLUSION Applying the triple pre-fenestration technique for aortic arch lesions was feasible and minimally invasive in our case.The technique provides a new avenue for thoracic endovascular aortic repair of Stanford type A aortic dissection.

Modified Double-Fenestrated Stent Graft for Branched Thoracic Endovascular Aortic Repair of an Irregular Aortic Arch Aneurysm:A Case Report

A 43-year-old male was admitted to General Hospital of Northern Theater Command with exacerbation of chest pain for 10 d.Computed tomographic angiography(CTA)showed an irregular aortic arch aneurysm involving the left subclavian artery(LSA),with penetrating aortic ulcer and intramural hematoma.A modified fenestrated thoracic endovascular aortic repair(TEVAR)technique was performed successfully.Follow-up CTA showed that stent grafts were well-apposed,without endoleaks,migration,or branch artery occlusion,and the hematoma was almost completely absorbed.In this case,precise fenestrations were created by measurements based on three-dimensional CT reconstruction and angiography.Furthermore,the physician chose an LSA approach to catch the guide wire and deployed branched stent grafts,considering the oblique direction of this branch and the small size of the fenestration.This case shows that pre-fenestrated and inner bare stent enhancing TEVAR is a safe and feasible technique for repair of complicated aortic arch aneurysm.