New Advances in Endovascular Therapy: Endovascular Repair of a Chronic DeBakey Type II Aortic Dissection With a Scalloped Stent-Graft Designed for the Ascending Aorta.

PURPOSE: To describe the deployment into the ascending aorta of a fenestrated stent-graft with a scallop for the innominate artery.

TECHNIQUE: A 72-year-old multimorbid patient presented with a chronic DeBakey type II aortic dissection of the ventral ascending aorta with close proximity (16 mm) to the innominate artery. A 1-piece, 46-mm-diameter Zenith Ascend Thoracic Endovascular Graft with circumferential diameter-reducing sutures (ProForm) was custom made with a 15×30-mm scallop for the innominate artery. The stent-graft was loaded on a Z-Trak Plus Introducer System with a 20-F hydrophilic-coated sheath and successfully implanted under inflow occlusion in a procedure that lasted 35 minutes.

CONCLUSION: The use of fenestrated stent-grafts in the ascending aorta is feasible, and a scallop in the distal stent-graft can extend coverage of the ascending aorta in pathologies close to the innominate artery. This technique broadens the range of endovascular options for patients not suitable for open surgery.