Endovascular graft deployment in the false lumen of type B dissection

Objective: Thoracic endovascular aortic repair (TEVAR) is particularly indicated in a patient with complicated type B dissection. The object of this communication is to report a case of deployment of the endograft in the false lumen, to propose a protocol in order to prevent it and discuss the possible surgical options when this complication has occurred. Methods: A case of complicated acute type B dissection is described where the endovascular prosthesis was positioned in the false lumen. The literature on the subject is briefly reviewed for the insertion techniques and conversion to surgery. Results: The occurrence was recognized and treated with replacement of the entire aorta from the sinotubular junction to a level of the eighth thoracic vertebra under deep circulatory arrest with selective antegrade cerebral perfusion. Conclusions: TEVAR for complicated type B dissection should be carried out according to a precise and stepwise protocol in institutions familiar with all the different options of conversion to open repair.