Antegrade laser fenestration and superior mesenteric artery (SMA) stenting (8 × 32 mm Advanta V12 stent graft, Maquet Getinge, Getinge, Sweden) were performed through a 32 × 200 mm polyester thoracic stent graft (Zenith TX2, Cook Aortic Interventions, Bloomington, IN, USA) to treat a complicated acute type B dissection in a 74 year old male patient. Unsuccessful stenting of the coeliac artery (CA) required coil embolisation. Post-operatively, the patient presented with persistent melaena due to severe gastric ischaemia. (A) A symptomatic, severe extrinsic compression of the stent between the close struts of the distal segment of the TX2 was observed. The stenosis persisted despite a novel stent in stent placement (7 × 38 mm Advanta V12). Due to compromised iliac vessels and thrombus formation in the TX2 stent graft, an antegrade approach was preferred. (B) An aorto-SMA bypass (8 mm polyester conduit) with a side to side venous conduit to the CA using a retrosternal transdiaphragmatic route was performed, with satisfactory six month outcomes supplemented by dual antiplatelet therapy.
