case_images: PMC11650284_01
case_images: (A) Sagittal view computed tomography (CT) scan of retrograde type A dissection with the primary entry in the descending thoracic artery (arrow). (B) CT reconstruction after zone 2 arch replacement showing distal suture line just proximal to left subclavian artery (LSA). (C) CT reconstruction after staged thoracic endovascular aortic repair (TEVAR) starting just distal to the 16 mm debranching graft in the proximal ascending aorta to the celiac trunk, level of the Knickerbocker technique is depicted. Note also the LSA-left common carotid artery (LCCA) bypass and the Amplatzer plug in the proximal LSA (to prevent endoleak).
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case_images: PMC11650284_01_gr1.jpg
case_images: fig1
case_images: Distally, the true lumen (TL) was narrowed but patent, without signs of malperfusion (Fig 1). TEVAR of approximately 3 cm in length (Fig 1), as described previously by us and others. The postoperative course was uneventful. Completion fluoroscopy showed no endoleaks, a completely excluded FL at the entire thoracic level, as well as a patent LCCA-LSA bypass graft (Fig 1).
case_images: Coronal view of the computed tomography (CT) scans all at the same level (trachea bifurcation) showing dissection with total diameter preoperatively (A) and postdissection dilatation (B), result after thoracic endovascular aortic repair (TEVAR) (C) and favorable remodeling 3 months after TEVAR (D).
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case_images: PMC11650284_01_gr2.jpg
case_images: fig2
case_images: At the 3-month follow-up, the entire DTA had remodeled completely (Fig 2).