Page 36 - Read Online

Buia et al. Vessel Plus 2022;6:48 https://dx.doi.org/10.20517/2574-1209.2022.04 Page 5 of 9

Figure 3. CT volume rendering reconstruction of post-dissection thoraco-abdominal aneurysm with a very narrow true lumen and
visceral arteries all originated from the true lumen (A, B); patient was treated with BEVAR and positioning of coils in the false lumen in
the diaphragmatic tract (arrow) (C); and false lumen was thrombosed in the thoracic and suprarenal abdominal aorta, and a small type
II endoleak was detected in the subrenal aorta (arrow) (D).

visceral stent graft at 18 months of 100% for the arteries anterogradely revascularized and 91.2% for the
retrogradely revascularized. The advantages of this technique reside in the ready availability of all the
necessary “armamentarium”, with the possibility of treating emergency situations with different and
multiple solutions according to the anatomy of the aorta and visceral vessels. The disadvantages are the
demanding procedure, in particular in the choice of the correct oversizing of the aortic stent graft as well as
of the type of visceral stent graft (balloon versus self-expandable and exact length and diameter) and, as for
BEVAR/FEVAR solutions, the narrowness and stiffness of the true lumen. If the true lumen is too narrow to
receive more than two stent grafts, an anterograde approach is recommended (preferably the left brachial or
axillary artery) for the reconstruction of the mesenteric superior artery and celiac trunk, as well as a
retrograde access for the renal arteries. Intentional coverage of celiac trunk and small accessories renal
arteries (< 5 mm) should be considered, especially in emergency cases. Moreover, a self-expanding bare
metal stent can be added to reduce the risk of compression or kinking of the parallel stent graft. However,
long-term outcomes (especially patency of visceral branches) and large sample size studies are needed to
evaluate the safety and efficacy of this technique in the treatment of post-dissection thoracoabdominal
aortic aneurysms.

COMMENTARY AND CONCLUSION
Incomplete thrombosis of the FL with persistent backflow from distal re-entry tears is one of the major
limitations of TEVAR in TBAD and is independently associated with poor long-term survival. Over the
[25]
last few years, different techniques such as STABILIZE and Knickerbocker [26,27] have been developed to
prevent this fearful complication already from the first treatment, especially in the acute phase when, due to
the elasticity and minor thickness of the intimal flap, it is possible to destroy it, in order to create a single
lumen and stop backflow in the FL. In this article, we do not voluntarily describe these techniques, because,
in our opinion, they are most effective if applied in the acute/subacute phase, in relation to the greater
elasticity of the intimal flap, as already reported. We therefore focus this review on the endovascular