Published online Mar 6, 2020. doi: 10.12998/wjcc.v8.i5.954
Peer-review started: November 3, 2019
First decision: December 4, 2019
Revised: January 14, 2020
Accepted: February 15, 2020
Article in press: February 15, 2020
Published online: March 6, 2020
Processing time: 123 Days and 23 Hours
A 46-year-old male underwent ascending aortic replacement, total arch replacement, and descending aortic stent implantation for Stanford type A aortic dissection in 2016. However, an intraoperative stent-graft was deployed in the false lumen inadvertently. This caused severe iatrogenic thoracic and abdominal aortic dissection, and the dissection involved many visceral arteries.
The patient had pain in the chest and back for 1 mo. A computed tomography scan showed that the patient had secondary thoracic and abdominal aortic dissection. The ascending aortic replacement, total arch replacement, and descending aortic stent implantation for Stanford type A aortic dissection were performed 2 years prior. An intraoperative stent-graft was deployed in the false lumen. Endovascular aneurysm repair was performed to address this intractable situation. An occluder was used to occlude the proximal end of the true lumen, and a covered stent was used to direct blood flow back to the true lumen. A three-dimensional printing technique was used in this operation to guide pre-fenestration. The computed tomography scan at the 1stmo after surgery showed that the thoracic and abdominal aortic dissection was repaired, with all visceral arteries remaining patent. The patient did not develop renal failure or neurological complications after surgery.
The total endovascular repair for false lumen stent-graft implantation was feasible and minimally invasive. Our procedures provided a new solution for stent-graft deployed in the false lumen, and other departments may be inspired by this case when they need to rescue a disastrous stent implantation.
Core tip: In this work, we report an extremely rare case of repair for intraoperative stent-graft deployed in the false lumen of Stanford type A aortic dissection. This is very rare because the patient survived this catastrophic thoracic surgery for 2 years. We performed a well-designed total endovascular repair to draw blood back to the true lumen. Our report presents a new solution for incorrect stent-graft implantation. Other departments may be inspired by this case when they need to rescue an incorrect stent implantation. Moreover, we discuss regular rescue methods and preventive measures used for stent implantation of the false lumen.