Comments:
The rate of spinal cord ischemia after TEVAR is 6-10% [3, 5]. In
contrast, in the Study of Thoracic Aortic Type B Dissection Using
Endoluminal Repair (STABLE I), favorable results were found with the
Zenith Dissection Endovascular System (Cook Medical, Bloomington, Ind)
with a 30-day paraplegia rate of 1.8% [4]. Less disruption of
spinal cord perfusion with the use of bare metal stent, continued false
lumen compression to encourage thrombosis and remodeling [7].
There is limited data on TEVAR/EVAR for MFS patients and only a few case
reports presented PETTICOAT technique for MFS patients [6]. A study
reported that the rate of the primary treatment failure in MFS patients
treated with TEVAR/EVAR was 44% due to endoleaks [2]. We present a
patient who is a member of a subset of MFS patients who can benefit from
TEVAR as a rescue therapy. This was true both because of the clinical
presentation, and the timing of her presentation during the COVID-19
pandemic surge. If there was a problem that made her unable to be
extubated, we would have to stay in the OR on the anesthesia machine
until a ventilator was delivered as there was no available ventilator in
the hospital. The patient will be followed closely for the need for
surgical repair.