2025 Volume 34 Issue 2 Pages 43-47
A 76-year-old man with multiple comorbidities including pulmonary dysfunction and chronic kidney disease was admitted to our hospital with acute aortic dissection associated with a thoracic aortic aneurysm. He had undergone axillary-bifemoral bypass surgery for infrarenal occlusive disease 4 years prior to presentation. During hospitalization, the dissecting thoracic aortic aneurysm rapidly dilated and surgical intervention was considered. Because of the high surgical risk of open thoracic graft replacement, we performed an endovascular repair of this aortic pathology. An antegrade approach through the ascending aorta was chosen due to the difficulty of a conventional retrograde approach and other inadequate peripheral access. A median full-sternotomy was performed and after careful assessment of the ascending aorta using epi-aortic scan echo, a 22 Fr. sheath was cannulated into the ascending aorta using a 3-0 Ethibond purse-string suture. Three pieces of aortic endograft (c-TAG, W. L. Gore & Associates) were then placed from the level of Th6 to Th12. Completion angiography showed no endoleak. Although the patient required temporary hemodialysis, he recovered well with no neurological deficit and no aortic events at 6 months follow-up. This report highlights the potential efficacy of thoracic endovascular aortic repair via the ascending aorta as an alternative to conventional access or the cervical vessels.
