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Simplified hybrid repair with true lumen recycling for retrograde renovisceral perfusion in a complex chronic aortic dissection  Ricardo Castro-Ferreira,

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Presentation on theme: "Simplified hybrid repair with true lumen recycling for retrograde renovisceral perfusion in a complex chronic aortic dissection  Ricardo Castro-Ferreira,"— Presentation transcript:

1 Simplified hybrid repair with true lumen recycling for retrograde renovisceral perfusion in a complex chronic aortic dissection  Ricardo Castro-Ferreira, MD, Paulo Gonçalves Dias, MD, Sérgio Moreira Sampaio, MD, José Fernando Teixeira, MD, Mario Lachat, PhD  Journal of Vascular Surgery Cases and Innovative Techniques  Volume 4, Issue 3, Pages (September 2018) DOI: /j.jvscit Copyright © 2018 The Author(s) Terms and Conditions

2 Fig 1 Schematic image of the imaging findings when the patient was referred to the vascular department: type I thoracoabdominal aortic aneurysm, thrombosed right common iliac artery aneurysm (60-mm thoracic aorta and 50-mm abdominal aorta; 40 mm in the right common iliac artery), and thrombosed right renal and left internal iliac arteries. The dissection had an apparent origin in the Dacron-descending thoracic aorta anastomosis. The false lumen (FL) was dominant and compressed the true lumen (TL), which had just 1-cm diameter. All remaining visceral arteries—left renal, superior mesenteric, and celiac—originated in the TL. Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, DOI: ( /j.jvscit ) Copyright © 2018 The Author(s) Terms and Conditions

3 Fig 2 Schematic image of the first step in treatment—open aortoiliac bypass with preservation of both lumens in the infrarenal aorta, with additional reinforcement of the infrarenal aorta and anastomosis with Dacron (wrap technique). Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, DOI: ( /j.jvscit ) Copyright © 2018 The Author(s) Terms and Conditions

4 Fig 3 Intraoperative photograph highlighting both lumens in the infrarenal aorta and the Dacron that will further reinforce the infrarenal aorta and anastomosis (wrap technique). Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, DOI: ( /j.jvscit ) Copyright © 2018 The Author(s) Terms and Conditions

5 Fig 4 Schematic image of the second step in treatment—exclusion of the dissection's origin by endografting of the entire false lumen (FL) with three successive thoracic endoprostheses. The proximal landing zone was just distal to the left subclavian artery. The distal landing zone was in the infrarenal aorta reinforced by the Dacron. True lumen (TL) perfusion was maintained by two periscopes with self-expanding bare-metal nitinol stents. Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, DOI: ( /j.jvscit ) Copyright © 2018 The Author(s) Terms and Conditions

6 Fig 5 Preoperative, postoperative, and 16-month three-dimensional computed tomography angiography reconstructions. Total coverage of the thoracoabdominal aorta can be appreciated. The celiac trunk and superior mesenteric and left renal arteries are all successfully perfused through true limb salvage using two periscopes. Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, DOI: ( /j.jvscit ) Copyright © 2018 The Author(s) Terms and Conditions

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