A Laser Fenestration Technique To Facilitate Tevar In Thoracic Aortic Aneurysms With Chronic Dissection
Vasileios Bouris, MD, MSc, Allan M. Conway, MD, Khalil Qato, MD, Derek R. Brinster, MD, Alfio Carroccio, MD.
Lenox Hill Hospital, New York, NY, USA.
Title: A laser fenestration technique to facilitate TEVAR in thoracic aortic aneurysms with chronic dissection
Introduction: There has been an increase in utilization of thoracic endovascular aortic repair (TEVAR) to treat aneurysms with chronic dissection. Despite significant progress, TEVAR is hindered by persistent perfusion of the false lumen and aneurysm growth. Various techniques to address false lumen perfusion exist. We preset our experience of laser fenestration with disruption of the dissection flap to facilitate TEVAR and avoid persistent retrograde false lumen perfusion.
Methods: Two patients presenting with thoracic aortic aneurysm complicated by chronic dissection underwent a TEVAR procedure with final goal to treat the aneurysm and avoid retrograde false lumen perfusion. Under IVUS guidance, we performed a Phillips/Spectranetics laser fenestration of the intimal flap followed by a scissoring technique to obliterate the dissection flap and create a distal seal zone. Stent-grafts placed following flap obliteration allow graft opposition to the entire outer aortic and avoid retrograde perfusion of the false lumen.
Results: Two patients underwent TEVAR in conjunction with laser obliteration of the dissection flap, including one undergoing primary repair of a chronic Type B dissection with aneurysm, and one as a completion second stage elephant trunk procedure. Technical success was achieved in both cases, with successful implantation of the endograft, and freedom from type I and III endoleaks. Absence of false lumen flow, and patency of the visceral vessels was confirmed on completion angiography. True lumen patency and obliteration of the intimal flap were confirmed by IVUS. Early follow up confirms exclusion of the aneurysm, with no evidence of retrograde perfusion of the false lumen.
Conclusions: Thoracic aortic aneurysms in the context of chronic dissections can be successfully treated with TEVAR and laser obliteration of the chronic dissection flap to fully exclude the aneurysm and avoid retrograde false lumen perfusion.
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