Secondary Thoracoabdominal Aortic Replacement Following Total Arch Repair With a Sutureless Integrated Stented Graft in Marfan Syndrome: A Case Report.

BACKGROUND Secondary thoracoabdominal aortic replacement after a total arch repair is a complex procedure that has a risk of complications such as stroke and renal failure. Patients with Marfan syndrome are more at risk of distal aortic re-interventions. This report describes a 52-year-old woman with Marfan syndrome and a history of type A aortic dissection treated with total arch replacement and frozen elephant trunk implantation using a sutureless integrated stented graft (SISG), who presented 3 years later with a distal aortic dissection aneurysm requiring secondary thoracoabdominal aortic replacement. CASE REPORT A 52-year-old woman with Marfan syndrome underwent ascending aortic and total arch replacement with frozen elephant trunk implantation using a sutureless integrated stented graft (SISG) for acute type A aortic dissection 3 years earlier. One month before the current operation, thoracoabdominal aortic replacement was performed because follow-up imaging demonstrated false lumen expansion of the residual thoracoabdominal aortic dissection, with a maximal diameter exceeding 5.5 cm. Intraoperatively, significant false lumen thrombosis and obliteration were observed in the elephant trunk region. A 2-cm unstented graft segment at the distal end of the elephant trunk facilitated proximal anastomosis in the current surgery. Given the patient's Marfan syndrome, all branch vessels were reconstructed. Follow-up aortic computed tomography demonstrated satisfactory morphology, and the patient was discharged 2 weeks after surgery. CONCLUSIONS This case demonstrates successful staged repair of residual thoracoabdominal aortic dissection following initial total arch replacement using a SISG in a patient with Marfan syndrome. The sutureless graft facilitated secondary procedure by providing a suitable proximal landing zone, with complete false lumen thrombosis confirming effective primary repair and favorable outcomes.