(NVKP-16-1-2016-0017 National Heart Program) Funder: NRDIO
(2020-1.1.6-JOVO-2021-00013)
(K135076)
Thematic Excellence Program (Semmelweis University)(2020-4.1.1.-TKP2020) Funder: Ministry
for Innovation and Technology
A late complication of aortic dissection is the dilatation of the weakened aortic
wall. The only urgent endovascular alternative to high-risk open surgery in the treatment
of postdissection aneurysms is branched endovascular aortic repair (BEVAR), which
is extremely difficult due to the intimal membrane in the aorta lumen and the compressed
true lumen. In this case report, we present the first application of BEVAR for aortic
dissection in Hungary. Our 76-year-old male patient underwent type B aortic dissection
13 years before, for which supraaortic debranching was followed by thoracic stent
graft implantation. The patient was admitted with acute chest pain associated with
a "con-tained" rupture of a ten centimetre dilatation of the thoracoabdominal aorta.
Our aortic team recommended endo-vascular surgery due to the extremely high risk of
open surgery, which the patient accepted. Following selective embolization of the
proximal segment of the left subclavian artery, a complex aortic intervention was
performed. A new thoracic stent graft was started from the in situ thoracic graft,
followed by a branched thoracoabdominal graft, the four branches of which were connected
to the celiac trunk, the superior mesenteric artery and the two renal arter-ies. We
also implanted a bifurcation graft under the branched graft and a left iliac bifurcation
graft due to the complex dissection of the left iliac artery system. After an uneventful
procedure, the patient was discharged home on the fourth postoperative day.
