Abstract
The goal of thoracic endovascular aortic repair (TEVAR) for chronic Stanford type B aortic dissection (TBAD) is to avoid rupture by inducing false lumen thrombosis. However, branch arteries originated from false lumens have been reported to cause residual blood flow and inhibit thrombosis, resulting in false lumen dilatation even after TEVAR. We describe a chronic TBAD case in which intercostal arteries embolization combined with TEVAR promoted false lumen thrombosis leading to favorable aortic remodeling 1 year after the procedure. The patient was a 49-year-old man with a thoracic aortic aneurysm found incidentally on computed tomography (CT). The dissection onset time was unclear as he had not displayed any prior symptoms, but the images of aortic wall (which were thickened and had an unmovable septal flap) suggested a chronic dissection. The patient was young enough to tolerate open surgery, so a 2-staged hybrid procedure was planned. A total arch replacement combined with frozen elephant trunk was performed with moderate hypothermic circulatory arrest (28°C) and selective antegrade cerebral perfusion. Three months later, we performed TEVAR with intercostal artery embolization. During the procedure, false lumen angiography revealed 7 intercostal arteries originating from the false lumen, and we embolized 4 of these with orifices enough wide to insert a catheter. Subsequently, we performed TEVAR to close intimal tears of the descending thoracic aorta. The postoperative course was uneventful, and the patient was discharged on the eighth day after surgery without complications. Postoperative CT scans after 1 year showed false lumen shrinkage and favorable aortic remodeling. This case indicates that intercostal artery embolization combined with TEVAR in chronic TBAD could be effective in promoting thrombosis in false lumens, but further study is needed to confirm the types and numbers of arteries which should be embolized to promote these effects.
