Lobato technique for acute type B aortic dissection complicated by thoracoabdominal aortic aneurysm and total true lumen occlusion of the infrarenal aorta

A 63-year-old man had presented for emergency endovascular treatment of acute type B aortic dissection complicated by acute occlusion of the true lumen of the infrarenal aorta and a Crawford type III thoracoabdominal aortic aneurysm. These findings precluded the use of a conventional endovascular approach. A novel technique was developed with the insertion of guidewires through the left femoral and subclavian arteries to deliver stent grafts to cover the dissection entry tear and exclude the thoracoabdominal aortic aneurysm. A femorofemoral bypass was performed to preserve the circulation. The procedure and follow-up course were uneventful. This technique appears to be a promising tool for thoracic endovascular aortic repair in emergency setting. More experience with the method is warranted.