Abstract / Summary
We report the case of an 86-year-old woman who developed an intraoperative type B aortic dissection during ascending aortic replacement for an ascending aortic aneurysm.Postoperative imaging demonstrated an uncomplicated dissection extending to the infrarenal aorta.At 10 weeks, follow-up imaging revealed rapid aneurysmal expansion of the false lumen.Thoracic endovascular aortic repair was performed with adjunctive cerebrospinal fluid drainage, rapid pacing, and image fusion guidance.An intimal fenestration technique was used to optimize the distal sealing zone, extending the disruption from a pre-existing re-entry tear.A type Ib endoleak necessitated additional stent-graft deployment, which in turn caused occlusion of the left renal and superior mesenteric arteries.The STABILISE technique (stent-assisted balloon-induced intimal disruption and relamination in aortic dissection repair) with a PETTICOAT (Provisional Extension To Induce Complete Attachment) bare stent restored renal perfusion, and targeted stenting re-established mesenteric flow.A postprocedural pseudoaneurysm was managed conservatively and resolved with spontaneous thrombosis within 48 hours.The patient was discharged on postoperative day seven, asymptomatic, with complete exclusion of the dissection, patent visceral vessels, and no endoleak confirmed at six-week follow-up.This case illustrates that combining distal flap fenestration with STABILISE relamination and a comprehensive endovascular toolkit can successfully manage complex chronic type B aortic dissections, even in elderly, high-risk patients-provided that adequate perioperative safety measures and a broad endovascular armamentarium are available to address unanticipated complications.