Endovascular repair of thrombosed-type acute Type A aortic dissection with critical renal artery malperfusion

An 81-year-old woman was referred to our centre for emergency surgery with a suspected diagnosis of acute aortic dissection. Laboratory tests showed marked elevation of serum creatinine and blood urea nitrogen. Enhanced computed tomography (CT) demonstrated Type A aortic dissection with a thrombosed false lumen in the ascending aorta. The primary entry tear was located 2 cm distal to the left subclavian artery. Malperfusion of bilateral renal arteries was also evident due to compression by the false lumen. Considering her poor preoperative condition, thoracic endovascular repair of the entry was performed. The primary entry tear was covered using a covered Zenith TX-D stent graft, and a supplemental non-covered Zenith TX-D stent was deployed from the distal edge of the stent graft to the infrarenal aorta. After 5 days of dialysis and additional renal angioplasty for the stenotic left renal artery, her renal function recovered to normal. Her postoperative course was uneventful. Enhanced CT 1 month after surgery showed obliteration of the false lumen of the ascending aorta and patent renal arteries bilaterally.