[Surgical treatment of a patient with complications after endovascular procedure for type B aortic dissection (a clinical case report)].

The incidence of aortic dissection varies from 3 to 10 cases per 100.000 people. According to the International Registry of Acute Aortic Dissection (IRAD), type B aortic dissection accounts for 33%. The mean age of these patients is 63 years, with two thirds of them being males. The past two decades have witnessed an increase in the use of thoracic endovascular aortic repair (TEVAR) and hybrid methods of treatment from 7 to 31%, with a decrease in the proportion of open operations from 17 to 8%. In the current guidelines of the European Association for Cardio-Thoracic Surgery (EACTS) and the Society of Thoracic Surgeons (STS) as of 2024, TEVAR is considered a first-choice treatment procedure in patients with complications (class IB) in the acute phase and in high-risk patients (class IIa C) in the subacute phase. The main task of TEVAR is to close the proximal primary tear of the aortic intima, to exclude the false channel from blood flow, to initiate thrombosis of the false channel and dilatation of the true one. During TEVAR, there is a possibility of developing a specific complication, i. e., the formation of distal stent-graft induced new entry (dSINE). The mechanism of its development is multifactorial, with an important role given to fragility of the damaged aortic wall, rigidity of the stent graft, as well as the tendency of the graft to return to its original straight shape. The publications devoted to this subject in the literature are scarce. This complication occurs in 9.72-36.6% of patients. Mortality can reach 25%. Most authors make a choice in favor of repeat endovascular intervention. In this clinical case report, we describe surgical treatment of a 35-year-old male patient with acute type B aortic dissection after the development of dDINE within 1 month after emergency TEVAR. After TEVAR, the proximal fenestration was closed, with the development of thrombosis of the false lumen. However, the patient on the background of poorly controlled arterial hypertension developed a series of life-threatening complications. Performing an open operation on the thoracoabdominal aorta resulted in regression of spinal disorders and sustained clinical improvement.