Figure Legends
Figure 1. Preoperative computed tomography (CT) revealed type A acute
aortic dissection. (A) Three-dimensional CT. (B) Primary entry tear
located in the distal aortic arch. (C/D) True lumen of the ascending
aorta, abdominal aorta, and superior mesenteric artery were severely
compressed by the false lumen. Dilated and fluid-filled small bowel
loops suggested mesenteric malperfusion.
Figure 2. (A) Primary entry tear was identified at the distal aortic
arch under direct vision. (B) Intraoperative transesophageal
echocardiography revealed true lumen (TL) stenosis and false lumen (FL)
expansion in the downstream aorta. (C) Aortography. White and red arrows
showed the levels of panels D, E, and F. (D, E, F) Intravascular
ultrasound revealed FL expansion and TL stenosis at all levels. The
stiff guidewire was introduced in the FL at the level just distal to the
misdeployed frozen elephant trunk (D) across the dissecting flap at the
perforation point (E; red arrow) and in the TL of the descending aorta
(F). TL, true lumen; FL, false lumen
Figure 3. Postoperative computed tomography (CT). (A) An endograft was
deployed from the inside of the FET to the TL of the descending aorta
across the perforated dissecting flap (white arrow). (B, C, D) The FET,
additional endograft, the true lumen of the SMA, and the abdominal aorta
were patent without any stenosis