Case presentation
A 35-year-old female with MFS presented with chest pain, abdominal pain, and numbness in right extremity. She was hemodynamically stable. On examination, her right leg was colder than the left one with no dopplerable distal pulses. Computed tomography (CT) scan showed Stanford type B aortic dissection (TBAD) from proximal descending aorta to the right common iliac artery (CIA), which was occluded. The true lumen (TL) was 95% compressed by false lumen (FL) (Fig 1A and B). The celiac artery (CA), superior mesenteric artery (SMA), and left renal artery (RA) were perfused from FL. The flow to the right renal and CIAs were significantly decreased due to TL compression (Fig 1C and D). She was taken emergently to the operating room (OR). The procedure was performed under general anesthesia. Bilateral common femoral arteries were accessed percutaneously. Intravascular ultrasound examination was performed to confirm true lumen placement of the wires (Fig 2A and B). A 28 mm x 109 mm Zenith Alpha Thoracic Endovascular Graft (Cook Medical, Bloomington, Ind) was deployed into the proximal descending aorta covering the primary tear site (Fig 2C). Significant compression of TL persisted (Fig 2D). Therefore, a 36 x 180 mm bare metal Zenith Dissection Endovascular Stent (Cook Medical, Bloomington, Ind) was placed down to the CA (Fig 2E). An aortogram confirmed antegrade filling of the CA, SMA, and right RA. The left RA was supplied from FL via distal fenestration (Fig 2F). The previously collapsed right CIA was fully re-expanded and the right pedal pulses became palpable. The patient was extubated and transferred to intensive care unit. The patient was stable overnight with no neurological deficits and normal creatinine level. Due to high risk of infection with COVID-19, she was discharged home 20 hours after surgery. Follow up was performed via frequent phone calls and she was seen in the office at two weeks.