Endovascular Exclusion of a Post-Dissection Thoraco-Abdominal Aneurysm With False Lumen Implant of Frozen Elephant Trunk + Branched EVAR

Introduction: Aneurysmal degeneration in patients with chronic type B dissection is common, occurring 20% – 40% of cases, which 10% develop late rupture. Open surgery for these cases associated high morbidity and mortality. Endovascular alternatives include fenestrated or branched endografts, although the use devices may be complex. Treatment usually involves implantation a device true lumen objective excluding false lumen. The authors report case where surgical aortic arch debranching frozen elephant trunk (FET) were performed, intentionally deploying endovascular component lumen, followed by EVAR therefore from circulation. Report: A 65 year old male history hypertension, dyslipidaemia, renal insufficiency was referred aneurysmal (maximum diameter at arch: 56 mm; descending thoracic aorta: 85 abdominal 60 mm). left artery, coeliac trunk, superior mesenteric artery all originated right staged procedure planned. In first stage, carotid-subclavian bypass ostial occlusion subclavian performed. Subsequently, supra-aortic trunks FET third procedure, custom made endograft deployed extending component. 12 mm non-compliant balloon used to widen existing fenestration level arteries allow access artery. distal implanted non-dilated portion infrarenal aorta, below large pre-existing fenestration. complicated extreme tortuosity aorta. completion angiogram revealed adequate proximal sealing patency visceral branches. Late perfusion excluded observed, as result patent intercostal arteries. Discussion: repair dissections challenging. Implantation endografts possible alternative selected when main branches originate sufficient accommodate its