Utility of dual longitudinal diameter-reducing ties in aortic arch thoracic endovascular aortic repair

A 69-year-old man underwent open surgical ascending aortic replacement for type-A aortic dissection. Six months after this operation, he became symptomatic. There was persistent chest pain even though anti-hypertensive treatment was effective. Computed tomography angiography showed a widening false lumen (FL) in the aortic arch and in the thoracic aorta (Figure 1). The patient was not suitable for open aortic arch replacement due to high risk (logistic EuroSCORE 34.47%). Standard thoracic endovascular aortic repair (TEVAR) or branched endovascular repair (e.g. COOK) [1] was not considered due to insufficient landing zone distal to a right coronary artery venous bypass graft arising from the ascending aortic graft.