First in man: sealing the distal re-entry tears of aortic dissection after thoracic endovascular aortic repair by an ENDOPATCH™ system

Abstract

A 73-year-old man presented with a history of thoracic endovascular aortic repair for aortic dissection 10 years earlier. Computed tomography angiography revealed post-dissection aneurysm (maximum diameter 5.6 cm) with incomplete thrombosis of a false lumen (Panel A) and multiple distal re-entry tears [two on the descending thoracic aorta (Panels B and C) and others on the left renal artery and both iliac arteries; see Supplementary material online , Video S1]. The ENDOPATCH™ has an implant and a matched delivery system.¹ The implant, which has a double-disc structure connected by a short central waist, crossed the re-entry tears through the steerable delivery sheath (Panel D) and released each disc on both sides of the re-entry tear sequentially (Panels E and F). Finally, a mechanical interlock stabilized the two attached discs on the intimal flap (Panel G). Following intercostal artery embolization, the ENDOPATCH entered the false lumen through the re-entry tear on the right iliac artery (Panel H), and the implants were released successively to seal the two separate re-entry tears on the descending thoracic aorta (Panel I); Supplementary material online , Video S2 illustrates the first implant release in detail. Intraoperative angiography showed that both implants obtained an adequate sealing effect (see Supplementary material online , Video S3). Other re-entry tears were conventionally covered by stent graft. Computed tomography angiography 12 months later showed that both implants were well fixed without surrounding endoleak and complete thrombosis in the false lumen (Panels J–L; Supplementary material online , Video S4).