Zhang M, Tong YH, Liu C, Li XQ, Liu CJ, Liu Z. Treatment of Stanford type A aortic dissection with triple pre-fenestration, reduced diameter, and three-dimensional-printing techniques: A case report. World J Clin Cases 2021; 9(1): 183-189 [PMID: 33511183 DOI: 10.12998/wjcc.v9.i1.183]
Corresponding Author of This Article
Zhao Liu, MD, PhD, Doctor, Professor, Surgeon, Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 21008, Jiangsu Province, China. liuzhao83@gmail.com
Research Domain of This Article
Medicine, Research & Experimental
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jan 6, 2021; 9(1): 183-189 Published online Jan 6, 2021. doi: 10.12998/wjcc.v9.i1.183
Treatment of Stanford type A aortic dissection with triple pre-fenestration, reduced diameter, and three-dimensional-printing techniques: A case report
Ming Zhang, Yuan-Hao Tong, Chen Liu, Xiao-Qiang Li, Chang-Jian Liu, Zhao Liu
Ming Zhang, Yuan-Hao Tong, Chen Liu, Xiao-Qiang Li, Chang-Jian Liu, Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
Zhao Liu, Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 21008, Jiangsu Province, China
Author contributions: Zhang M and Tong YH contributed equally to this work; Li XQ, Liu CJ, and Liu Z designed the research study; Zhang L, Liu C, and Liu Z performed the research; Tong YH analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.
Supported byJiangsu Provincial Medical Youth Talent Foundation, No. QXRC201621; Outstanding Youth Project supported by Nanjing Medical Science and Technology Development Foundation, No. JQX17003; and Social Development Program of Jiangsu Province, No. BE2019604.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhao Liu, MD, PhD, Doctor, Professor, Surgeon, Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 21008, Jiangsu Province, China. liuzhao83@gmail.com
Received: May 27, 2020 Peer-review started: May 27, 2020 First decision: September 13, 2020 Revised: September 30, 2020 Accepted: November 12, 2020 Article in press: November 12, 2020 Published online: January 6, 2021 Processing time: 218 Days and 22.4 Hours
Abstract
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 pre-fenestration, 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.
Core Tip: In this work, we report a treatment of Stanford type A aortic dissection by triple pre-fenestration, reducing diameter, and three-dimensional-printing technique. We performed a well-designed total endovascular repair in a patient in which the dissection involved three branches of aortic arch and the ascending aorta. Moreover, we discussed the advantage of three-dimensional-printing technique to guide the application of modified triple pre-fenestrated stent-graft to treat Stanford type A aortic dissection. Temporarily reducing stent diameter was also vital for success of the operation.
