# Hybrid endovascular treatment for complicated aortic dissection concomitant with true lumen obliteration: a case report

## TL;DR

A 74-year-old man with a complicated aortic dissection was successfully treated using a two-stage hybrid endovascular approach.

## Contribution

The paper demonstrates the feasibility of combining CERAB and DDMT techniques for true lumen obliteration.

## Key findings

- The bidirectional approach enabled successful recanalization of the collapsed true lumen.
- The combined CERAB and DDMT technique minimized type Ⅲ endoleak in the infrarenal segment.
- Hybrid endovascular treatment provided a minimally invasive solution for complex aortic dissection.

## Abstract

Thoracic endovascular aortic repair (TEVAR) has been widely introduced. However, unestablished transfemoral approach due to true lumen obliteration disables endovascular option.

A 74-year-old male with a history of 15-year-ago type B aortic dissection presented with chronic bilateral lower extremity claudication. CT angiography revealed that a large entry tear was located at distal to the left subclavian artery. The thoracic aneurysmal degeneration progressed and eventually required repair. True lumen of infrarenal aorta to bilateral common iliac arteries was totally collapsed by false lumen, and the re-entry tear was open at external iliac artery. Initially, we performed recanalization to the collapsed true lumen. Bidirectional approach was taken from right brachial and bifemoral arteries. The covered endovascular reconstruction of aortic bifurcation (CERAB) technique and double D-shape moulding technique (DDMT) was performed to create covered stent configuration. As secondary treatment, 1-debranching TEVAR with axillary artery bypass was successfully performed by utilizing femoral approach.

This case demonstrated feasibility of two-stage endovascular therapy for thoracic aneurysmal degeneration concomitant with true lumen obliteration. This combined technique of CERAB and DDMT was absolutely effective to minimize type Ⅲ endoleak in infrarenal segment. Hybrid endovascular treatment offered minimally invasive therapy to the patient.