Stent-graft treatment of type B aortic dissection involving the right aortic arch: case report

Endovascular Treatment for Acute Type B Aortic Dissection Involving a Right-sided Aortic Arch and Kommerell's Diverticulum: A Case Report and Review of the Literature

BACKGROUND

Aortic dissection involving a right-sided aortic arch (RAA) associated with Kommerell's diverticulum is extremely rare and remains a complicated entity for surgical therapy because of its anatomical characteristics. Fewer than 40 cases have been reported in the English language literature to date.

METHODS

We reported a case of 69-year-old male patient who presented with acute type B aortic dissection involving an RAA associated with Kommerell's diverticulum, a stent-graft was accurately deployed and embolization of the left subclavian artery. In addition, a review of the literature was performed to examine its clinical presentation and the efficacy of management strategies.

RESULTS

One year follow-up showed positive aortic remodeling with exclusion of Kommerell's diverticulum and thrombosis of the false lumen.

CONCLUSIONS

An aortic dissection involving an RAA associated with Kommerell's diverticulum is an extremely rare condition. Endovascular therapy is technically feasible when the dissection involves this unusual vascular malformation.

Endovascular repair of a type B aortic dissection with a right-sided aortic arch: case report

Right-sided aortic arch is a rare anomaly, and aortic dissection involving a right-sided aortic arch is extremely rare. We report the case of a 65-year-old man with a right-sided aortic arch and a right descending aortic dissection and a stent-graft was accurately deployed without perioperative complications. There were no any complaints and complications after 18 months follow-up. The CTA demonstrated that the false lumen was largely thrombosed only with a mild type II endoleak and a mild descending aortic expansion. We feel that endovascular repair is feasible to patient of type B aortic dissection with a right-sided aortic arch. However, long-term clinical efficacy and safety have yet to be confirmed.

Stent - Graft Placement for Mycotic Aneurysm of the Thoracic Aorta-Report of a Case-

A 66-year-old man was found to have a mycotic aneurysm of the thoracic aorta. It was first suspected to be a pseudoaneurysm of the descending thoracic aorta on computed tomography scan, and the blood cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA). It was subsequently diagnosed as a mycotic aneurysm, but because the patient continued to do so poorly with septicemia, conventional surgery (ie, aortic exclusion and extraanatomic bypass, or surgical placement of in situ graft) was not performed. A stent-graft device composed of several units of self-expandable Z stents covered with ultra-thin woven Dacron was inserted through 21F sheath via the left external iliac artery and aortography showed successful deployment without blood endoleaks. The procedure was completed without incident and the patient has continued to do well. Endovascular stent-grafts may offer significant advantages for patients at high surgical risk.

Midterm results of stent-graft repair for thoracic aortic aneurysms: computed tomographic evaluation

Midterm observation of endovascular surgery using a fabric-covered stent graft for thoracic aortic aneurysms is discussed with postoperative follow-up findings based on regularly performed thoracic computed tomography (CT). From 1996 to 1999, 20 patients with thoracic aortic aneurysm underwent stent-graft placement in our hospital. One year follow-up CT results after placement were obtained for 17 patients. The CT scans found that there were both thrombosis and size reduction of aneurysm in 8 patients (46%), thrombosis without size reduction in 2 (13%), a new ulcerlike projection (ULP) in 3 (19%), persistent minor endoleakage in 2 (13%), a new endoleak in 1 (6%), and a recurrent endoleak from intercostal arteries in 1 (6%). The new ULP formation seemed to be a peculiar problem stemming from an intimal injury caused by edges of the stent. Therefore, we recently adopted a new spiral stent instead of the previous stent to avoid the injury. The new endoleak suggested that aneurysmal thrombosis without size reduction could cause the aneurysm to develop recurrent endoleaks. From these findings, we concluded that midterm observation of stent-graft repair for thoracic aortic aneurysms did not give satisfactory results. In order to improve the results of endovascular surgery using stent-grafts, we need to develop safer stent grafts with a reliable design to prevent endoleaks and to avoid intimal injury of the aorta. We also hope to develop effective technologies that can accelerate organization of thrombus in the aortic aneurysm after stent-graft placement.