Single-stage total thoracoabdominal endovascular repair for acute non-A non-B aortic dissection with retrograde extension to the ascending aorta and concomitant abdominal dissecting aneurysm: a case report.

backgroundAcute non‑A non‑B aortic dissection represents a complex and high-risk condition. Traditional treatment protocols mandate emergency open surgical repair for any dissection involving the ascending aorta (Stanford Type A or DeBakey Type I/II). With ongoing advancements in endovascular devices, less invasive options are emerging as viable alternatives for select high-risk patients with ascending aortic involvement, potentially offering advantages over total arch replacement. CASE PRESENTATION: A 73-year-old male presented with one week of chest and back pain and was diagnosed with acute non‑A non‑B aortic dissection with the primary entry tear located in the descending aorta (Ishimaru zone 3) extending retrogradely to the ascending aorta. Computed tomography angiography and three-dimensional reconstruction revealed an acute non‑A non‑B aortic dissection with a primary entry tear located at the Ishimaru zone 3, extending retrograde to the root of the ascending aorta and antegrade to the bifurcation of the iliac arteries. The left renal artery originated entirely from the false lumen, and the abdominal dissecting aortic aneurysm had a maximum diameter of 61 mm.Because the patient had not undergone any aortic imaging before symptom onset, it is not possible to definitively determine whether this lesion represents a pre-existing aneurysm or a chronic dissecting aneurysm with secondary false lumen dilatation. Based on the continuous dissection flap extending from the thoracic aorta into the infrarenal segment and the presence of partial false lumen thrombosis, we tend to favor that the 61 mm dilatation represents false lumen aneurysmal degeneration following the acute dissection. Given that the aneurysmal lesions in the visceral segment met established criteria for intervention and that staged repair carried a risk of interval rupture, a single-stage total endovascular reconstruction was performed following thorough discussion and at the request of the patient's family. The reconstruction extended from the level distal to the origin of the left common carotid artery to the iliac bifurcation. A physician-modified endograft was deployed, and a fenestration was precisely aligned with the origin of the left subclavian artery, through which a Viabahn

conclusionsThis case report describes a patient with acute non‑A non‑B aortic dissection complicated by an abdominal aortic aneurysm who achieved a favorable outcome following single-stage endovascular repair. The patient did not develop paraplegia postoperatively, and following occlusion of the proximal thoracic aortic entry tear, the ascending aortic intramural hematoma resolved and underwent favorable remodeling. This case suggests that single-stage endovascular repair may serve as an alternative treatment option for patients at high risk for open thoracic surgery.