Fenestrated and branched endovascular aortic repair for chronic type B aortic dissection with thoracoabdominal aneurysms Atsushi Kitagawa, MD, Roy K.

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Fenestrated and branched endovascular aortic repair for chronic type B aortic dissection with thoracoabdominal aneurysms Atsushi Kitagawa, MD, Roy K. Greenberg, MD, Matthew J. Eagleton, MD, Tara M. Mastracci, MD, Eric E. Roselli, MD Journal of Vascular Surgery Volume 58, Issue 3, Pages 625-634 (September 2013) DOI: 10.1016/j.jvs.2013.01.049 Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 1 The classification of chronic type B aortic dissection. A, left panel, Extensive dissection is defined as an aortic dissection extending from the arch (right upper panel) through the visceral segments (right middle and lower panels) with type II or type III thoracoabdominal aortic aneurysm (TAAA). If the arch was also involved in aneurysmal change with the TAAA, the extent of the aortic disease is classified as “extensive aorta.” B, Focal dissection is defined as an aortic dissection limited to an intimal tear that abutted the visceral segment (upper left and upper right panels) that may extend into the iliac vessels (lower right panel) but not into the thoracic aorta (lower left panel). Journal of Vascular Surgery 2013 58, 625-634DOI: (10.1016/j.jvs.2013.01.049) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 2 Fenestrated and branched endovascular aortic repair (FEVAR) for chronic type B dissection extending from arch to descending thoracic and thoracoabdominal aorta (extensive dissection) with branched arch graft are shown in preoperative and postoperative (top) computed tomography (CT) and (bottom) volume-rendered images. Journal of Vascular Surgery 2013 58, 625-634DOI: (10.1016/j.jvs.2013.01.049) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 3 Actuarial survival curves of fenestrated and branched endovascular aortic repair (FEVAR) in the Kaplan-Meier analysis are shown for group A (n = 15; black line) and group B (n = 15; dotted line), with the error bars showing the standard error. Journal of Vascular Surgery 2013 58, 625-634DOI: (10.1016/j.jvs.2013.01.049) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 4 Depicted is sac behavior in all patients with ≥6-month follow-up for group A (n = 10) and group B (n = 11). A white bar means decrease (<−5 mm), a gray bar as stable (−5 to 5 mm), and a black bar is an increase (>5 mm). Although the mean sac regression was similar between two groups (−6.8 mm in group A vs −11.4 mm in group B; P = .43), the only two patients with growth were in group A, both in patients with patch aneurysms and connective tissue diseases. Journal of Vascular Surgery 2013 58, 625-634DOI: (10.1016/j.jvs.2013.01.049) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 5 A persistent endoleak through the distal re-entry of the superior mesenteric artery (SMA; *) resulted in retrograde filling into the false lumen (white arrows) after fenestrated endovascular aneurysm repair for chronic type B aortic dissection is shown in a (A) computed tomography (CT) and (B) angiogram. The translumbar embolization using coils and AMPLATZER Vascular Plug (St. Jude Medical, St. Paul, Minn) plugs (black arrows) was performed to occlude the false lumen near the origin of the SMA. The angiogram shows the (C) right anterior oblique view and (D) the frontal view. Journal of Vascular Surgery 2013 58, 625-634DOI: (10.1016/j.jvs.2013.01.049) Copyright © 2013 Society for Vascular Surgery Terms and Conditions