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Case Reports
. 2024 Jun 21;19(1):339.
doi: 10.1186/s13019-024-02825-5.

Aortic arch de-branching for suspected expanding perigraft haematoma after previous acute type-A dissection repair with AMDS stent: a technique for a potential future problem

Rickesh Karsan  1 , Niamh Shearer  2 , Ciara Doyle  2 , Rachel Roberts  2 , Alsir Ahmed  2
Affiliations
Case Reports

Aortic arch de-branching for suspected expanding perigraft haematoma after previous acute type-A dissection repair with AMDS stent: a technique for a potential future problem

Rickesh Karsan et al. J Cardiothorac Surg. .

Abstract

Background: Acute Stanford type- A aortic dissections make up a large part of emergency cardiac surgery. They also carry a significant burden of morbidity. New techniques to aid aortic remodelling include the Ascyrus Medical Dissection Stent (AMDS): Its increasing use, looks to present a potential problem in cases where surgery involving the aortic arch may be required.

Case report: We present the case of a 49-year-old male who underwent urgent redo-surgery for total arch replacement and de-branching following recent replacement of the ascending aorta for acute type-A dissection, where an AMDS stent was deployed. The patient underwent total arch replacement with a stented tri-furcate prosthesis and de-branching of arch vessels with the stent landed inside the previous AMDS, to good effect.

Conclusion: This case highlights a possible approach to aortic arch surgery in patients who have previous had AMDS insertion.

Keywords: Acute stanford-a aortic dissection; Aortic arch; Ascyrus medical dissection stent.

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Conflict of interest statement

Not applicable.

Figures

Fig. 1
Fig. 1
(A-B) CT aortogram showed an expanding perigraft haematoma (orange arrow). (C) Angiogram appearances suggestive of an ongoing leak at the proximal end of the stent, with opacification of the false lumen arising around the innominate artery origin and propagating through the descending thoracic aorta into the thoracoabdominal segment
Fig. 2
Fig. 2
(A) Intraoperatively the suspected perigraft haematoma was actually a contained seroma, this was opened (blue arrow). (B) The repair involved a frozen elephant trunk with trifurcate graft. The original interposition graft was resected to leave a cuff just above the sino-tubular junction proximally. The Frozen Elephant Trunk device was deployed through the AMDS device and sutured in place. The arch vessels were de-branched and anastomosed to the trifurcate branches before a graft to graft anastomosis of the proximal and distal aortic grafts were completed
Fig. 3
Fig. 3
(A) CT aorta post repair showing resolution of the perigraft seroma with no contrast extravasation. (B) 3D reconstruction showing the FET within the AMDS
See this image and copyright information in PMC

References

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