Hybrid aortic debranching with intentional dual-lumen placement of a bifurcated endograft for the repair of a complex aortic dissection

We present the case of a patient with a chronic type B aortic dissection (AD) following TEVAR with aneurysmal degeneration involving the thoraco-abdominal and iliac segments. Given the patient's comorbidities and anatomy, she was not a candidate for complete open or endovascular repair. We elected to perform a hybrid debranching procedure with endograft extension into the iliac arteries. However, given the small diameter of the true lumen, the grafts would be unable to expand. With the use of large septal fenestrations, we extended from the previously placed thoracic endograft using a bifurcated device, utilizing one limb through the true lumen landing into the right common iliac artery, and the other weaved via the false lumen and landing within the true lumen of the left external iliac artery (utilizing a modification of the False Lumen Intentional Placement or “FLIP” technique). Follow-up imaging at 1 and 2 years revealed false lumen thrombosis, no endoleaks, stable sac size, and patent endografts.