A Case of Successful Hybrid Treatment for Chronic Type B Dissection in a Patient with Bilateral Occlusion of Iliac Arteries

Abstract

Hybrid techniques to enable endovascular treatment of complex aortic pathology have been previously described. A staged endograft repair of a complex, chronic Stanford type B aortic dissection with atherosclerotic occlusion of bilateral iliac arteries is reported in a 66-year-old man. The patient also had chronic obstructive lung disease as well as chronic renal dysfunction. The aneurysmal portion of the dissection extended from the distal arch to the entire thoracic aorta. Bilateral femoral arteries were bypassed from the abdominal aorta using open techniques. Then, total arch replacement with a frozen elephant trunk was performed through median sternotomy. Finally, the aneurysmal portion was completely covered with an endograft from the frozen elephant trunk to the upper abdominal aorta, just proximal to the celiac trunk. The patient had no neurologic complications. This case report illustrates the feasibility of the hybrid technique in selected high-risk patients when confronted with complex aortic pathology.