We present the case of a 48-year-old woman with an acute type A aortic dissection that was treated with thoracic endovascular aortic repair at our institution. The patient was found to have a focal type A dissection with pericardial effusion but no tamponade physiology and no involvement of the aortic valve or root. We elected to treat the patient's type A aortic dissection with an endovascular stent because of the patient's favorable anatomy and no evidence of neurologic deficits or signs of distal malperfusion. The patient was successfully treated with an abdominal aortic cuff deployed through the axillary artery. An axillary approach was necessary because of the short length of the delivery sheath preventing a transfemoral delivery. At 2-year follow-up, the patient remains free of complications with computed tomography scan revealing complete false lumen thrombosis and a stable endovascular repair. This report demonstrates a case of acute type A aortic dissection successfully treated using thoracic endovascular aortic repair and illustrates the utility of axillary cannulation for precise deployment of stent grafts in the ascending aorta.
From the Division of Cardiovascular Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA USA.
Accepted for publication January 25, 2017.
Disclosures: Grayson H. Wheatley, III, MD, is a consultant for Medtronic, Inc, Minneapolis, MN USA, Bolton Medical, Sunrise, FL USA, Lombard Medical Inc, Irvine, CA USA, and TriVascular, Inc, Santa Rosa, CA USA. Corbin E. Muetterties, BS, Jeremy H. Conklin, DO, and G. William Moser, CRNP, declare no conflicts of interest.
Address correspondence and reprint requests to Grayson H. Wheatley, III, MD, Centennial Heart & Vascular Center, 2400 Patterson St, #307, Nashville, TN 37203 USA. E-mail: firstname.lastname@example.org.