Efficacy of VIABAHN for the Re-entry of the Right Renal Artery in the Case of Chronic Type B Thoracoabdominal Dissected Aneurysm

Shuhei Azuma＊	Masafumi Morita＊	Sho Mano＊
Ryo Shimada＊

（Department of Cardiovascular Surgery, Kyoto Katsura Hospital＊, Kyoto, Japan）

This case report aimed to evaluate the efficacy of applying VIABAHN endoprosthesis at the dissection re-entry of the right renal artery after thoracic endovascular aortic repair（TEVAR）in a patient with a chronic type B dissected thoracoabdominal aneurysm. A 78-year-old man was given a diagnosis of type B aortic dissection 5 years ago and underwent a successful TEVAR operation. Two years later, he developed complications such as chronic expanding aortic dissections;thus, he underwent a second endovascular repair. Enhanced computed tomography（CT）scanning at the five-year follow-up after initial endovascular repair showed a 58-mm diameter thoracoabdominal dissected aneurysm. It also showed an apparent entry point dissection arising from the lower thoracic aorta and a re-entry point at the base of the right renal artery. Although the right renal artery was affected by the dissecting false lumen, all other abdominal branches were intact. He was treated with VIABAHN via occlusion of the re-entry of the dissection and reconstruction of the right renal artery. The patient recovered uneventfully and was discharged 10 days after the operation. Postoperative enhanced CT scanning showed that the aortic false lumen was completely thrombosed, and the right renal arterial flow had significantly improved. Although TEVAR is the standard treatment in acute complicated type B dissections, its role in chronic type B dissections remains controversial. Our technique of using VIABAHN for the reconstruction of the right renal artery showed promising results for patients with chronic type B dissections.

 

Jpn. J. Cardiovasc. Surg. 47:293-297（2018）

Keywords：re-entry;VIABAHN;chronic type B thoracoabdominal dissected aneurysm;TEVAR