Case:
A male in his 60s experienced acute type A aortic dissection in 2015 and
underwent Bentall‘s operation. In 2020, contrast-enhanced CT revealed
an open false lumen from the distal arch to the abdominal aorta with an
enlarged false lumen, leading to total arch replacement with FET.
Postoperatively, thrombosis of the false lumen progressed, and the
diameter of the distal arch decreased (Fig 1(A)). In 2023, the patient
presented with chest and back pain. Contrast-enhanced CT showed blood
flow in the previously thrombosed false lumen and an enlargement of the
false lumen diameter (Fig. 1(B)(C)). 4D Flow MRI revealed accelerated
flow from the true lumen to the false lumen at the distal end of the FET
(Fig. 2(A)(B)), along with an increase in wall shear stress at the site
where the flow from the true lumen to the false lumen reached (Fig. 2(C
)). These findings led to the decision that the false lumen diameter
would further enlarge.
The strategy was to perform TEVAR for new entry closure. Aortic
angiography showed high-velocity blood flow from the true lumen to the
false lumen at the distal end of the stent graft (Fig. 3(A)(B)). TEVAR
was performed for dSINE, resulting in the disappearance of blood flow
into the false lumen, and the surgery was concluded (Fig. 3C).
Postoperative CT showed thrombosis of the false lumen and a reduction in
its diameter (Fig. 3D). After 6 months, the false lumen was thrombosed,
and its diameter continued to shrink.