Angioscopy-assisted thoracic endovascular aortic repair for chronic type B aortic dissection: Optimizing stent graft coverage and left subclavian artery coil embolization

We report the case of a 69-year-old man with chronic type B aortic dissection and progressive aneurysmal dilatation. Zone 2 thoracic endovascular aortic repair was performed with carotid-subclavian bypass. Nonobstructive general angioscopy identified additional tiny entry tears in the descending aorta, guiding adequate stent graft coverage. Subsequent left subclavian artery coil embolization under balloon occlusion revealed satisfactory packing on fluoroscopy, but angioscopy revealed residual flow through coil gaps, prompting additional coil placement. Blood flow cessation was confirmed by angioscopy. Completion angiography revealed no antegrade false lumen flow or endoleaks. Follow-up computed tomography at 3 months showed favorable aortic remodeling with complete thoracic false lumen thrombosis.