Satisfactory outcome of the complicated STABILISE technique for type B aortic dissection – a one year follow up

Acute Stanford type B aortic dissection (TBD) is emergency requiring treatment of complications: impending rupture, dilatation, pain, hypertension and malperfusion of organs. Provisional extension to induce complete attachment (PETTICOAT) technique has shown good results, however, some perfusion of the false lumen is maintained and aorta still has a tendency to grow distally. Evolution of this technique is known as stent-assisted balloon-induced intimal disruption and relamination (STABILISE). In the present case we would like to report one year follow up of STABILISE complicated aortic dissection repair. A 46 year old hypertensive male presented to the emergency department with thoracoabdominal back pain. Computed tomography angiography (CTA) confirmed TBD with entry tear located distal to the a. subclavia sin. Dissection extended to the aortic bifurcation. A. iliaca com. dx. was thrombosed by dissection flap (asymptomatic). Left renal artery emerged from the false lumen. Dissection flap extended in a. mesenterica superior and truncus coeliacus. STABILISE technique was performed, consisting of true lumen (TL) catheterization. Stent graft was deployed with proximal landing to cover the primary entry tear and a subclavia sin. Two dissection stents were deployed. A balloon was used to sequentially dilate the stents. Covered stent was deployed in a proximal part of a. mesenterica superior. The completion angiogram confirmed adequate sealing and complete realignment of the aorta with TL patency. A. renalis sin was occluded and a. iliaca dx lumen completely reestablished. One year follow up CTA revealed abdominal aorta distal tear in uncovered sent part which is going to be closed by covered stent. In our case, one year follow up demonstrated complete aortic remodeling, no aortic enlargement, thrombosed false lumen and good visceral organ perfusion. This case adds to the knowledge that the STABILISE technique is a valid endovascular alternative in treatment of emergent complicated aortic dissections.