Published online Jan 6, 2021. doi: 10.12998/wjcc.v9.i1.183
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
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.
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.
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.