We encountered a challenging case of endovascular repair for distal stent graft-induced new entry (SINE) using the AFX aortic cuff. Postoperative computed tomography revealed no endoleak with a preferable conformation change of the externally mounted graft material of the AFX cuff against the tear.

We describe a case of frozen elephant trunk deployment unintentionally malpositioned into the false lumen. An 83-year-old man underwent total arch repair with a frozen elephant trunk for type A acute aortic dissection complicated by mesenteric malperfusion. However, intraoperative transesophageal echocardiography showed expansion of the false lumen in the descending aorta, suggesting a malpositioned frozen elephant trunk into the false lumen. Endovascular fenestration of the dissecting flap and subsequent endograft deployment from the inside of the malpositioned frozen elephant trunk graft to the true lumen of the descending aorta was successfully performed under intravascular ultrasound guidance.

We encountered a challenging case of endovascular repair for distal stent graft-induced new entry (SINE) using the AFX aortic cuff. Distal SINE was detected on follow-up computed tomography in a 68-year-old man who previously underwent primary thoracic endovascular aortic repair for Stanford type B chronic aortic dissection. The AFX aortic cuff was deployed via a previous endograft to just above the super mesenteric artery with blockage of the celiac artery origin. Postoperative computed tomography revealed no endoleak with a preferable conformation change of the externally mounted graft material of the AFX cuff against the tear (active-seal fixation).

Background & Aim: Traumatic aortic injury (TAI) is a life-threatening condition. We present cases of 7 patients with TAI limited at the isthmus. Case description: Seven patients with TAI were treated between January 2015 and December 2018; TAI was caused by motor vehicle crashes in all cases. The patient characteristics and the post-operation data were collected and analyzed. We performed thoracic endovascular aortic repair (TEVAR) for five patients during their first hospitalization using Relay Plus® (Japan Lifeline, Japan). While patient 6 underwent TEVAR 5 years after the injury, patient 7 was recommended conservative care because she had dementia. Since most of these patients did not have a history of hypertension, they were not on antihypertensive medications after TEVAR. Conclusions: In cases of TAI, intervention by TEVAR in the acute phase improves the patient’s quality of life. Additionally, TEVAR is expected to prevent TAI from enlarging to form an aortic aneurysm.

Abstract Introduction: Left atrial dissection is a rare complication of cardiac surgery, most commonly associated with mitral valve surgery. Herein, we report on successful conservative treatment of left atrial dissection by avoiding anticoagulation. Case Report: A 64-year-old man developed left atrial dissection due to retrograde cardioplegia cannulation during operation for acute type A aortic dissection. As there was no connection between the left atrial dissection cavity and the left atrium on enhanced computed tomography, we did not administer anticoagulants to prevent expansion of the left atrial dissection cavity. However, the patient developed atrial fibrillation, which was successfully managed by beta-blocker and amiodarone administration. Follow-up imaging showed gradual left atrial dissection reduction, and the patient was started on anticoagulation therapy. Conclusion: We were able to resolve left atrial dissection by preventing the use of anticoagulation therapy in the acute stage by managing the atrial fibrillation with antiarrhythmic drugs.