Abstract
We report the first case of thoracic endovascular aortic repair (TEVAR) with a semi-custom made fenestrated thoracic stent graft for Stanford type B aortic dissection. 68-year-old man suddenly experienced severe back pain. He was taken to a hospital and was diagnosed with Stanford type B acute aortic dissection. The primary entry tear was located at the distal region of left subclavian artery. The aortic dissection extended to the right external iliac artery. He was transferred to our hospital. Despite medical management (decreasing blood pressures and bed rest), the diameter of the dissected aorta rapidly increased. The false lumen expanded and the true lumen became greatly compressed. Thoracoabdominal aortic replacement was too invasive for the patient because the length required to be replaced would be extending (Crawford type II thoracoabdominal aortic aneurysm). We therefore decided to perform primary entry closure with TEVAR. We selected Najuta thoracic stent graft system®, which is a semi-custom made fenestrated stent graft system. We performed TEVAR two months after the onset of aortic dissection. The surgical procedure was completed successfully. Postoperative enhanced computed tomography showed closure of the primary entry tear and expasion of the true lumen. The patient was discharged 28 days after TEVAR.
