Emergency Endovascular Rescue Using Fenestration for False Lumen Deployment of the Frozen Elephant Trunk in Aortic Rupture

A 65-year-old man presented with Stanford type B aortic dissection complicated by rupture of the distal aortic arch, originating from the false lumen. Due to the short distance between the supra-aortic branches, the lack of peripheral access from malperfusion, and the invasiveness of combined arch and descending aortic replacement via left thoracotomy, emergency total arch replacement with a frozen elephant trunk was chosen to close the primary entry and control the rupture. However, intraoperative deployment of the prosthesis into the false lumen was suspected due to increasing bleeding and transesophageal echocardiographic findings. Seamless endovascular fenestration of the dissection flap was performed intraoperatively using the tail of a stiff wire under fluoroscopic guidance. By adding stent grafts to the distal true lumen, bleeding from the ruptured aorta was successfully controlled. This case highlights the feasibility and utility of a rapid, simplified intraoperative endovascular fenestration technique in a critical emergency time setting, demonstrating a life-saving strategy when the device is inadvertently deployed into the false lumen.