case_images: PMC11416986_01
case_images: (A) Preoperative three-dimensional reconstruction of the aorta. (B) Multiple entry tears at the aortic arch, with the first tear located 8 mm distal to the origin of the left subclavian artery (highlighted by a red circle). (C) The superior mesenteric artery is supplied by both the true and false lumens simultaneously. (D) The left renal artery is supplied by the false lumen, while the right renal artery is supplied by the true lumen.
case_images: fcvm-11-1461511-g001.jpg
case_images: PMC11416986_01_fcvm-11-1461511-g001.jpg
case_images: F1
case_images: A CTA examination revealed a TBAD with multiple entry tears at zone 3 (Figures 1A,B). Both the true and false lumens were supplying blood to the superior mesenteric artery (Figure 1C). The left renal artery was supplied by the false lumen, while the right renal artery was supplied by the true lumen (Figure 1D).
case_images: Surgical procedure: (A) aortic angiography. (B,C) After the implantation of the first endograft, angiography revealed slow blood flow in the aorta, with no visualization of abdominal organs; a tear was visible at the distal end of the graft (highlighted by a red arrow). (D) Guidewire insertion through the right femoral artery into the true lumen of the aorta, with subsequent angiography showing visualization of the intercostal arteries and the right renal artery. (E,F) After implantation of the second covered stent graft, angiography showed restored aortic blood flow velocity and visualization of visceral arteries.
case_images: fcvm-11-1461511-g002.jpg
case_images: PMC11416986_01_fcvm-11-1461511-g002.jpg
case_images: F2
case_images: Access was obtained through the left femoral artery, and angiography confirmed the correct positioning of the guidewire in the "true lumen" of the aortic, with the intimal tear located 8 mm below the origin of the left subclavian artery (Figure 2A). However, subsequent angiography showed satisfactory blood flow in the arch arteries but a decrease in flow beyond the stent, with no visibility of the visceral arteries (Figure 2B). An intimal tear was observed at the T12 vertebra level (Figure 2C), suggesting possible misplacement of the stent graft into the false lumen. Angiography confirmed the position of the true lumen and visualized the left renal artery (Figure 2D). A second 30-26 200 mm Ankura II aortic stent-graft was then implanted, with its distal end placed at the T12 vertebra level (Figure 2E). Follow-up angiography demonstrated restored flow in the true lumen, with the celiac trunk, superior mesenteric artery, and both renal arteries clearly visualized (Figure 2F).
case_images: Postoperative three-dimensional reconstruction of the aorta. The distal end of the stent graft is positioned at the level of the T12 vertebra.
case_images: fcvm-11-1461511-g003.jpg
case_images: PMC11416986_01_fcvm-11-1461511-g003.jpg
case_images: F3
case_images: A CTA at the one-month postoperative follow-up showed no endoleak or false lumen expansion, with satisfactory perfusion of the abdominal organs (Figure 3).