Endovascular single-branched stent graft to treat complicated type B aortic dissection involving aortic arch anomalies

Abstract

Abstract Background The optimal treatment of complicated type B aortic dissection (cTBAD) involving arch anomalies remain unclear. Methods We consecutively enrolled patients with cTBAD involving arch anomalies who underwent endovascular repair using a single-branched stent graft (SBSG) at our medical center between January 2020 and January 2023. The demographics, clinical manifestation, operation detail, and follow-up outcomes of these patients were retrospectively collected and analyzed. Results A total of 16 patients (14 men; 55.8 ± 11.7 years) were enrolled, including isolated left vertebral artery (ILVA) (n = 6), aberrant right subclavian artery (ARSA) (n = 7), and right aortic arch and aberrant left subclavian artery (ALSA) with Kommerell’s diverticulum (KD) (n = 3). Among them, six patients with multi-branched arch anomalies. The endovascular management strategies of patients were diverse based on their aortic morphology. The early outcome demonstrated that one patient experienced an immediate intraoperative type Ia endoleak, which was resolved by balloon dilation, and two patients exhibited bird-beak configuration. After a median of follow-up of 910 (743–1023) days, the long-term outcome revealed that two patients developed endoleak. No death, retrograde type A aortic dissection (RTAD), paraplegia, stent graft-induced new entry tear (SINE), or branch section stenosis of SBSG were observed during the follow-up. Conclusion Our limited experience suggests that endovascular repair with a SBSG appears to be a relatively safe, feasible, and effective treatment option for patients with cTBAD and arch anomalies.

Keywords

• Complicated type B aortic dissection
• Aortic arch anomalies
• Thoracic endovascular aortic repair
• Single-branched stent graft
• Revascularization techniques