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. 2018 Oct 12;14:1993–2002. doi: 10.2147/TCRM.S177757

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© 2018 Zha et al. This work is published and licensed by Dove Medical Press Limited

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A 63-year-old man who presented with 3 months of chest and back pain was diagnosed with chronic TBAD with aneurysm degeneration (using patient 4 as an example). Total stent graft diameter and length were 36 mm and 200 mm, respectively. Two RBSs were implanted, and the diameter of the proximal RBS was 26 mm.

Notes: (A–C) Preoperative CTA and intraoperative angiography showing severe tortuosity of the descending aorta (TI =1.62) and collapsed TL (TR =0.89, OR =9.9). Intraoperative angiography verifying the TL collapse. (D, E) Two RBSs (black arrow) were first placed to reduce the angle between the distal end of the stent and the aorta and to locate the stent fixation site in a straight portion of the descending aorta. The stent graft was then deployed to seal the proximal entry tear, leaving its distal end partially within the RBS. (F, G) Postoperative angiography showing satisfactory repair of the dissected aorta using the RBS procedure. Meanwhile, the tortuosity of the descending aorta was corrected. TL was obviously expanded, and no endoleak was observed. (H) CTA at postoperative year 1 showing satisfactory occlusion of the aortic dissection with re-expansion of the TL and RBS collapse.

Abbreviations: TR, taper ratio; OR, oversizing ratio of the stent graft; TI, tortuosity index; TBAD, type B aortic dissection; RBS, restrictive bare stent; TL, true lumen; CTA, computed tomography angiography.

A 63-year-old man who presented with 3 months of chest and back pain was diagnosed with chronic TBAD with aneurysm degeneration (using patient 4 as an example). Total stent graft diameter and length were 36 mm and 200 mm, respectively. Two RBSs were implanted, and the diameter of the proximal RBS was 26 mm.

Notes: (A–C) Preoperative CTA and intraoperative angiography showing severe tortuosity of the descending aorta (TI =1.62) and collapsed TL (TR =0.89, OR =9.9). Intraoperative angiography verifying the TL collapse. (D, E) Two RBSs (black arrow) were first placed to reduce the angle between the distal end of the stent and the aorta and to locate the stent fixation site in a straight portion of the descending aorta. The stent graft was then deployed to seal the proximal entry tear, leaving its distal end partially within the RBS. (F, G) Postoperative angiography showing satisfactory repair of the dissected aorta using the RBS procedure. Meanwhile, the tortuosity of the descending aorta was corrected. TL was obviously expanded, and no endoleak was observed. (H) CTA at postoperative year 1 showing satisfactory occlusion of the aortic dissection with re-expansion of the TL and RBS collapse.

Abbreviations: TR, taper ratio; OR, oversizing ratio of the stent graft; TI, tortuosity index; TBAD, type B aortic dissection; RBS, restrictive bare stent; TL, true lumen; CTA, computed tomography angiography.