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Radner, Caroline ORCID logoORCID: https://orcid.org/0000-0002-0782-1456; Pichlmaier, Maximilian A.; Stana, Jan ORCID logoORCID: https://orcid.org/0000-0002-0013-7870; Buech, Joscha ORCID logoORCID: https://orcid.org/0000-0002-8749-2962; Hagl, Christian; Tsilimparis, Nikolaos ORCID logoORCID: https://orcid.org/0000-0002-6313-7595 und Peterss, Sven ORCID logoORCID: https://orcid.org/0000-0003-1880-152X (2024): “Loss of landing zone”—Stabilizing endovascular treatment solutions in the aortic arch after thoracic endovascular aortic repair. In: Journal of Vascular Surgery Cases, Innovations and Techniques, Bd. 10, Nr. 4, 101498 [PDF, 719kB]

Abstract

Addressing proximal complications that arise after endovascular aortic repair for type B aortic dissection, such as type Ia endoleaks, “bird-beaking” of the thoracic endovascular aortic repair (TEVAR) stent, retrograde type A dissection, and postdissection aneurysms, bears considerable complexities. We present a novel and safe method for open arch repair that can ensure a secure and efficient approach for TEVAR complications. The key element of the operative technique is approximating the grafted stent portion to the aortic wall and the arch prosthesis. The technique has successfully been implemented in 11 patients, who received secondary open arch repair from 2019 to 2022 after TEVAR for type B dissection. Our objective is not only to introduce this reliable concept but also to provide a comprehensive demonstration of its advantages and disadvantages compared with currently used open treatment methods and discuss patient outcomes after secondary open arch repair.

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