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