Total Endovascular Repair with Chimney Grafts for Distal Stent Graft-Induced New Entry After Type B Aortic Dissection

Abstract

The parallel graft technique is valuable for high-risk patients who are unfit for open repair and who have complex aortic lesions, such as distal stent graft-induced new entry (SINE). The patient had undergone thoracic descending aortic graft replacement because of dilatation of the distal aortic arch after optimal medical therapy for Type B aortic dissection. After 9 years, a new entry occurred at the level of the diaphragm. He was treated with thoracic endovascular aortic repair (TEVAR) due to rapid dilatation and his back pain. However, distal SINE occurred 1 month after TEVAR. Therefore, we performed chimney endovascular aortic repair to maintain perfusion to superior mesenteric artery and bilateral renal arteries. When using a prefabricated branched device in a narrow dissected true lumen, the possibility of selectively catheterizing a visceral branch often has no straightforward solution. However, parallel grafting is a flexible technique that had paramount importance for the surgical outcome in our case.