Balloon-Assisted True Lumen Expansion and Fenestration of a Symptomatic, Triple-Barrel, Postdissection Thoracoabdominal Aneurysm with Collapsed True Lumen to Facilitate Endovascular Treatment with a t-Branch.

BACKGROUND

To present the challenging endovascular treatment of a symptomatic triple-barrel (3 lumens; 1 true and 2 false lumens) aortic dissection case.

METHODS

A 43-year-old male was introduced with a symptomatic, 9 cm postchronic dissection thoracoabdominal aortic aneurysm with accompanying triple-barrel formation and true lumen collapse at the height of the distal thoracic aorta. The celiac axis and right renal artery were perfused from the true lumen, the left renal artery from the false lumen and the superior mesenteric artery from both lumens. Endovascular approach was decided due to the patient co-morbidities. Because of the collapsed true lumen, the aorta had to be preconditioned in order to facilitate the endovascular repair with a multibranched thoracoabdominal stent-graft. This was achieved through the dilation of the aortic true lumen with a 32 mm Coda balloon (COOK Medical, Bloomington, IN), then puncturing of the intimal flap in several places to create re-entries that were also dilated (first with a 12-mm noncompliant balloon and then with a compliant 32 mm Coda balloon), creating a single aortic lumen that could facilitate an endovascular repair with thoracic stent-grafts and an off-the-shelf multibranched endograft (t-Branch; COOK Medical). The patient was promptly discharged, and the 3-month follow-up CT-angiogram showed a satisfactory result with patent target vessels and only a small Type-IIb endoleak.

CONCLUSIONS

Preconditioning of the aorta using this technique is a feasible and safe approach for the treatment of complex thoracoabdominal postdissection aortic aneurysms presenting with a true lumen collapse.