Discussion
Although extremely rare, FET malposition into the FL is reported to be a fatal complication. Most cases of FET malposition into the FL were diagnosed using postoperative CT.2-4 Tamai et al. reported a case of FET malposition diagnosed by TEE during circulatory arrest that was successfully treated by additional FET deployment into the TL.5 In our case, FET malposition was suspected after weaning from CPB by TEE and pulseless SMA. Although FET removal and re-deployment or additional FET deployment into the TL could be alternative options, we performed endovascular rescue because additional cardiac and circulatory arrest could cause excessive invasion.
Fenestration of the dissecting flap using a radio frequency system and subsequent endograft deployment has been reported as an effective technique in cases of chronic dissection.4 However, percutaneous endovascular fenestration and endografting for FET malposition in cases of acute dissection have never been reported. Because the dissecting flap architecture is much thinner in acute dissection than in chronic dissection,6 the dissecting flap can be easily perforated only by a tapered tip microguidewire through an angled catheter under IVUS and fluoroscopic guidance.
In conclusion, percutaneous endovascular fenestration of the dissecting flap and subsequent endograft deployment from the FET to the TL of the descending aorta under the guidance of IVUS are effective and less-invasive surgical treatments after FET malposition into the FL for TAAD.