ABSTRACT 34

URGENT STENT-GRAFT REPAIR OF A LIFE THREATENING RETROGRADE DISSECTION OF THE AORTIC ARCH WITH A LUSORIA CAROTID ARTERY

A.S. Bortone, D. D’Agostino, S. Schena, G. Mannatrizio, V. Paradiso, M. Sciascia, E. De Cillis, L. de Luca Tupputi Schinosa
Division of Cardiovascular Surgery, DETO, University of Bari, Italy

We report the case of a 45 year-old caucasian who was admitted because of sudden pain between the shoulders and hypertension. An angio-CT scan showed dissection of the descending thoracic aorta. Eight days later, his clinical conditions suddendly worsened leading to acute renal failure, intestinal ischemia and severe chest pain. A further CT scan was positive for retrograde progression of the dissection along the entire arch. Because of patient's critical conditions, emergency endovascular stent-graft treatment was chosen. Therefore, the patient underwent urgent endovascular stent-graft repair of the dissection because of his critical conditions. Deployment of two prostheses in a "telescope" fashion was performed in order to cover the dissected part of the descending aorta and aortic arch, up to the origin of the brachiocephalic trunk. The procedure was eventually additioned with a right carotid-left subclavian artery bypass, in order to avoid ischemia of the left arm due to the covered origin of the left subclavian artery. The postoperative period was uneventful and the patient was discharged on day 7 in overall good condition.

This report demonstrates that the use of endovascular stent-grafts are feasible not only to treat the descending thoracic aorta but also a discrete portion of the aortic arch with the condition that the procedure must be completed with carotid-subclavian bypass in order to preserve the perfusion of the left arm.