Volume 38, Pages (January 2018)

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Presentation transcript:

Volume 38, Pages 15-18 (January 2018) Multiple Re-entry Closures After TEVAR for Ruptured Chronic Post-dissection Thoraco- abdominal Aortic Aneurysm R. Kinoshita, F. Ganaha, J. Ito, N. Ohyama, N. Abe, T. Yamazato, H. Munakata, K. Mabuni, T. Kugai EJVES Short Reports Volume 38, Pages 15-18 (January 2018) DOI: 10.1016/j.ejvssr.2018.01.002 Copyright © 2018 The Author(s) Terms and Conditions

Figure 1 Pre-operative computed tomography. (A) Three dimensional images, in the antero–posterior (AP) and postero–anterior (PA) views, showed a post-dissection thoraco-abdominal aortic aneurysm. The arrows indicate re-entry tears at the detached right lumbar arteries in the PA view. (B) A haematoma around a dilated descending false lumen indicates rupture (arrow). In the right thorax, there was a large chronic empyema (arrowhead). (C) A multiplanar reconstruction image showed a large re-entry tear at the detached right renal artery ostium (arrow). (D) Another major re-entry tear at the right iliac bifurcation (arrow). EJVES Short Reports 2018 38, 15-18DOI: (10.1016/j.ejvssr.2018.01.002) Copyright © 2018 The Author(s) Terms and Conditions

Figure 2 Multiple re-entry closures using aortic and branch endografts following TEVAR. Dots indicate the sites of re-entry tear. (A) After TEVAR, abdominal true lumen aortography showed marked ascending blood flow in the thoraco-abdominal false lumen (FL; arrows). (B) Re-entry at the detached right renal artery (RA) ostium (white dot) was closed using a covered stent. Re-entries at the detached right lumbar arteries (black dots) were closed by endovascular aneurysm repair, and both RAs were spared using the chimney technique. (C) Re-entry at the right iliac bifurcation (white dot) was closed by an iliac extender (arrow). (D) Two aortic extenders (arrows) were placed to close re-entries at the ostia of the detached bilateral inferior phrenic and left twelfth intercostal arteries (black dots) above the coeliac artery. (E) Completion aortography showed remaining FL retrograde flow from the re-entry at the ostium of the detached right first lumbar artery located between the coeliac and superior mesenteric artery (SMA), but it was significantly diminished (arrows). (F) Post-procedural three dimensional computed tomography (without contrast enhancement) shows all deployed endografts and the endovascular procedures that were performed. EJVES Short Reports 2018 38, 15-18DOI: (10.1016/j.ejvssr.2018.01.002) Copyright © 2018 The Author(s) Terms and Conditions

Figure 3 Computed tomography images (A–C) 3 days and (D) 4 months after thoraco-abdominal aortic aneurysm repair. (A, B) A patent thoracic false lumen (FL) was completely thrombosed (arrows), including the rupture site (arrowhead). (C) Coeliac level. Although the FL was not thrombosed (arrows), significant FL shrinkage was obtained. (D) After 4 months, further shrinkage of the thoracic FL was observed compared with the previous image at the same section B. The true lumen was fully expanded (arrows). EJVES Short Reports 2018 38, 15-18DOI: (10.1016/j.ejvssr.2018.01.002) Copyright © 2018 The Author(s) Terms and Conditions