Endovascular “Intimal Flap Septostomy” for Safe Landing of a Stent Graft in an Anastomotic Pseudoaneurysm of Chronic Type B Aortic Dissection()

OBJECTIVE/BACKGROUND: The purpose of this report is to demonstrate a novel endovascular technique for gaining and producing the maximal landing zone for a thoracic stent graft in a patient with a chronic type B aortic dissection. METHODS: The patient was a 64 year old man with chronic type B aortic dissection. He had developed acute type B aortic dissection and undergone descending thoracic replacement (Zone 2–Th10) 12 years earlier. During follow-up, he developed an anastomotic false aneurysm distally. In the initial operation, the distal anastomosis was performed with fenestration of the dissecting membrane. Computed tomography showed a pseudoaneurysm of 54 mm that was positioned 9 cm proximal to the coeliac artery. The landing zone was < 20 mm in the fenestrated area. At surgery, the true and false lumens were each cannulated from the femoral artery, and a pull through form was made just above the fenestrated flap. After the wire exchange, a 4 mm cutting balloon was positioned on the bottom of the flap, and the flap was gently sawed about 3.5 cm. RESULTS: After stent graft placement no endoleak was observed. The patient was discharged without any complications. CONCLUSION: This technique was effective in producing a sufficient landing zone for endovascular aortic repair in a patient with an anastomotic pseudoaneurysm of chronic type B aortic dissection.