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Page 4 of 9 Buia et al. Vessel Plus 2022;6:48 https://dx.doi.org/10.20517/2574-1209.2022.04

Figure 2. Multiplanar reconstruction of CT scan showing the measurement of the length and the largest diameter of the false lumen (A,
B) in a patient operated with the placement of a candy-plug in the false lumen above the celiac trunk (C, D).

BRANCHED AND FENESTRATED AORTIC ENDOPROSTHESIS
Branched and fenestrated stent grafts (BEVAR and FEVAR techniques) have increasingly become safe and
effective options for the treatment of thoracoabdominal aortic aneurysm (TAAA) and in selected cases with
[19]
specific anatomical conditions are considered the first-line treatment option . Unfortunately, their use to
promote thrombosis of the false lumen in TBAD previously treated with TEVAR has severe anatomical
limitations, primarily because the stiff and thickened intimal flap can limit the success of this strategy .
[20]
Furthermore, the true lumen may be very narrow, and the visceral vessels can arise from the FL or true
lumen, making BEVAR/FEVAR technically very demanding [Figure 3]. Moreover, BEVAR and FEVAR,
[21]
compared to the other described endovascular techniques, have a higher risk of complications, such as
injuries or ischemia of the parenchyma due to the manipulation of the visceral vessels and the patency of
the visceral stent grafts. Technically, fundamental is the right choice of the main graft and the bridging
stent, based on the anatomy of the aorta and visceral vessels, such as their diameter, extension, peripheral
ramifications, and relationship to the true and false lumens. In the planning of this type of procedure, it may
be useful, based on our experience, to consider the design of hybrid solutions (BEVAR and FEVAR) or the
use of inner branch and retro branch [Figure 4], to reduce the encumbrance within an often small true
lumen. Moreover, the use of preloaded guided wires could reduce the difficulty of the operation. In the case
of using branched solutions, it is preferable to use self-expanding visceral stents, with greater
conformability; in the case of FEVAR, the use of balloon expandable stents should be preferred to reduce
the risk of type IIIc endoleak.

Despite these limitations, through the continuous development of this emergent technique, in the future,
BEVAR/FEVAR will increasingly be used for the treatment of post-dissection thoracoabdominal aortic
aneurysms.

PARALLEL STENT GRAFT TECHNIQUE
The parallel stent graft technique (snorkel/chimney) [Figure 5] represents a valid off-the-shelf alternative in
the treatment of complex abdominal and thoracic aortic pathologies [22,23] . Liu et al. recently described a series
of 21 patients with chronic post-dissection thoracoabdominal aortic aneurysms treated with this
technique . Technical success was achieved in 17/21 (four intraoperative type I endoleaks spontaneously
[24]
resolved within one month), complete thrombosis of the FL was obtained in 19/21 with a patency rate of the