Distal Aortic Malperfusion Exacerbated by Antegrade Stent-Graft Placement During Hybrid Repair of Acute DeBakey Type I Aortic Dissection.

We present the case of an acute DeBakey type I aortic dissection with malperfusion. The patient underwent valve resuspension, ascending aortic and partial arch replacement, debranching of the innominate artery, and placement of a small-diameter stent within the left common carotid artery, after which antegrade deployment of a stent-graft into the proximal descending thoracic aorta was performed to expand the true lumen. Distal malperfusion was exacerbated by the stent-graft's traversal into the false lumen, necessitating further endovascular repair to reestablish flow to the distal aorta. Mitigation before stent-graft placement (for example, inserting a wire within the true lumen under fluoroscopic guidance to ensure stent-graft placement in the true lumen) and prompt corrective procedures are paramount, given the grim consequences of prolonged distal ischemia.