Treatment of Stanford type A aortic dissection with triple pre-fenestration, reduced diameter, and three-dimensional-printing techniques: A case report.

BACKGROUND: A 63-year-old female was diagnosed with acute Stanford type A aortic dissection. The patient had pain in the chest and back for 1 wk. The computed tomography angiography (CTA) showed Stanford type A aortic dissection (Myla type III aortic arch). The intimal tear was located at the top of the aortic arch and retrograded to the ascending aorta. CASE SUMMARY: Preoperatively, a three-dimensional (3D)-printed model of the aortic arch was made according to CTA data. Then, under the guidance of the 3D-printed aortic model, a pre-fenestrated stent-graft was customized, and the diameter of the stent-graft was reduced intraoperatively by surgeons. 3D printing, triple pre-fenestration, and reduced diameter techniques were used during the surgery. The CTA examinations were performed at the 3rd mo and 1st year after the surgery; the results showed that the aortic dissection was repaired without endoleak, and all three branches of the aortic arch remained unobstructed. CONCLUSION: Applying the triple pre-fenestration technique for aortic arch lesions was feasible and minimally invasive in our case. The technique provides a new avenue for thoracic endovascular aortic repair of Stanford type A aortic dissection.

Use of 3D Printing to Guide Creation of Fenestrations in Physician-Modified Stent-Grafts for Treatment of Thoracoabdominal Aortic Disease.

Purpose: To summarize the experience and outcomes of total endovascular repair of thoracoabdominal aortic disease using 3-dimensional (3D) printed models to guide on-site creation of fenestrations in aortic stent-grafts. Materials and Methods: From April 2018 to March 2019, 34 patients (mean age 58±14 years; 24 men) with thoracoabdominal aortic disease were treated in our department. Nineteen patients had thoracoabdominal aortic dissection and 15 had thoracoabdominal aortic aneurysm. Preoperatively, a 3D printed model of the aorta was made according to computed tomography images. In the operating room, the main aortic stent-graft was completely released in the 3D printed model, and the position of each fenestration or branch was marked on the stent-graft. The fenestrations were then made using an electric pen. Wires were sewn to the edge of the fenestrations using nonabsorbable sutures. After customization, the aortic stent-graft was reloaded into the delivery sheath and deployed. Results: The printing process took ~5 hours (1 hour for image reconstruction, 3 hours for printing, and 1 hour for postprocessing). The physician-modified stent-grafts had a total of 107 fenestrations secured by 102 bridging stent-grafts, including 73 covered stents and 29 bare stents. The average procedure time was 5.6±1.2 hours, including a mean 1.3 hours for stent-graft customization. No renal insufficiency or paraplegia occurred. Two branch arteries were lost during the operation. One patient (3%) died 1 week after surgery from a retrograde dissection rupture. One patient developed a minor cerebral infarction postoperatively. The mean follow-up time was 8.5 months. There was 1 endoleak from a fenestration (coil embolized) and 4 distal ruptures of the aortic dissection (3 treated and 1 observed). Conclusion: Three-dimensional printing can be used to guide creation of fenestrated stent-grafts for the treatment of thoracoabdominal aortic diseases involving crucial branches. This technique appears to be more accurate than the traditional measurement method, with short-term follow-up demonstrating the safety and reliability of the method. However, further research and development are needed.

Total endovascular repair of an intraoperative stent-graft deployed in the false lumen of Stanford type A aortic dissection: A case report.

BACKGROUND: A 46-year-old male underwent ascending aortic replacement, total arch replacement, and descending aortic stent implantation for Stanford type A aortic dissection in 2016. However, an intraoperative stent-graft was deployed in the false lumen inadvertently. This caused severe iatrogenic thoracic and abdominal aortic dissection, and the dissection involved many visceral arteries. CASE SUMMARY: The patient had pain in the chest and back for 1 mo. A computed tomography scan showed that the patient had secondary thoracic and abdominal aortic dissection. The ascending aortic replacement, total arch replacement, and descending aortic stent implantation for Stanford type A aortic dissection were performed 2 years prior. An intraoperative stent-graft was deployed in the false lumen. Endovascular aneurysm repair was performed to address this intractable situation. An occluder was used to occlude the proximal end of the true lumen, and a covered stent was used to direct blood flow back to the true lumen. A three-dimensional printing technique was used in this operation to guide pre-fenestration. The computed tomography scan at the 1stmo after surgery showed that the thoracic and abdominal aortic dissection was repaired, with all visceral arteries remaining patent. The patient did not develop renal failure or neurological complications after surgery. CONCLUSION: The total endovascular repair for false lumen stent-graft implantation was feasible and minimally invasive. Our procedures provided a new solution for stent-graft deployed in the false lumen, and other departments may be inspired by this case when they need to rescue a disastrous stent implantation.