Helios Hospital Erfurt: First aortic stent with side arm implanted in Thuringia
An innovative aortic stent with an integrated side arm (Gore TAG TBE) was successfully implanted for the first time in Thuringia at the Helios Hospital in Erfurt. This procedure was used to treat a complex aortic dissection in the chest of a 65-year-old patient in a minimally invasive way - without an open bypass and with a short recovery time.
Mrs. B. (65 years old) suffered an acute tear (dissection) of the aorta in April 2024. The aortic dissection extended from the chest to the abdomen. At the time, this was manifested by severe pain in the chest and back area. One of the causes of this was the patient's high blood pressure over many years. During the acute phase of this illness, the patient was stabilized in the intensive care unit at Helios Hospital Erfurt by drastically reducing her blood pressure and effective pain therapy combined with strict physical rest.
After this stabilization, the patient was discharged from the normal vascular surgery ward after approx. 14 days. However, after 6 months, the planned vascular surgery follow-up using computer tomography revealed a significant enlargement (aneurysm) of the torn aorta in the chest area with an increase in diameter of over 1 cm in just 6 months.
Together with the patient, we then decided on the indication for surgical treatment of the aortic dissection. This involves closing the beginning (entry) of the aortic wall tear (dissection) in the chest area just behind the exit of the left brachial artery in the area of the aortic arch in order to prevent further progression of this aortic dilatation (aortic aneurysm). This is increasingly being performed from the inside, i.e. in the vessel (endovascular) using a large watertight aortic stent in order to keep the procedure as small as possible for the patient. However, one technical difficulty with this procedure is the secure sealing of this large stent in the aorta.
As the aortic dissection begins just behind the vascular outlet for the left brachial artery, this vessel often has to be included in the sealing zone of the stent (overstenting). In recent years, a bypass from the left cephalic artery to the left brachial artery had to be surgically created in order to supply the left arm and the left posterior cerebral artery with sufficient blood. There was always a certain risk of a stroke or circulatory disorder in the left arm during this bypass operation.
Since last year, a new special stent for the aorta in the chest with an integrated side arm has been approved in Germany. This comes from the company "Gore" and bears the name TAG-TBE. The abbreviation TAG stands for Thoracic Aortic Graft and the abbreviation TBE for Thoracic Branch Endoprosthesis. This new stent prosthesis enables a larger sealing zone of the stent in the aorta, as this special aortic stent overlaps the outlet of the left brachial artery. This is only possible because this aortic stent has a specially designed side arm for the left brachial artery. This meant that Mrs. B.'s aortic dissection could be successfully treated surgically.
The large aortic stent (TAG-TBE) was inserted via the inguinal vessels and the small extra stent for the left brachial artery could be inserted into the brachial artery via this aortic stent. This allowed the aortic wall tear and the resulting aortic dilation to be successfully treated from the inside without an additional bypass and Mrs. B. was able to leave the clinic after only a few days. This special stent implantation with an integrated side arm for the left brachial artery was successfully performed for the first time in Thuringia in the vascular surgery department at Helios Hospital Erfurt.
