Page 51 - Virtual Vascular Vol 4

In view of end-organ mal-perfusion (left kidney), deranged renal

function and difficult to control hypertension, he was treated by

thoracic endovascular aortic repair (TEVAR) with intentional coverage
of left subclavian artery origin to achieve an adequate proximal landing

zone, aiming to cover the entry intimal tear distal to left subclavian

artery and redirect blood to true lumen. Intravascular ultrasound and
intraoperative angiogram were used to ensure placement of guidewire

along the true lumen. Left vertebral artery was hypoplastic and left

common carotid artery to left subclavian artery bypass graft was
deemed unnecessary. As left renal artery was perfused from the false Right renal

lumen, left renal artery stenting was done through fenestration from artery from

the true lumen. Finally, left subclavian artery embolization was done to true lumen Left renal artery
perfused via
prevent Type II endoleak. fenestration

from true lumen

to false lumen

Intraoperative fluoroscopy
showed infra-renal aorta

and right renal artery

Cook Dissection

Animation.mp4
Diss2.mp4

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