“Aortic dissection in a patient with Marfan syndrome managed with multilayer flow modulator”
Victor Costache MD PhD 1, Crina Solomon MD MSc 1, Radu Popa MD 1, Mihai Sandu 1, Cristian Bucurenciu 1, Gabriela Candea 1, Santa Adrian MD 2, Tatiana Melnic MD2, Anca Chitic MD2, Andreea Costache MD 1
Purpose: Patients with Marfan syndrome frequently develop aneurysms and dissections that involve multiple aortic segments. We report a case of a Marfan patient with a symptomatic aneurysm of left subclavian artery who underwent repair by a new approach. Instead of open surgical resection, an endovascular solution was successfully applied by use of a multilayer flow modulator stents (MFM) to exclude the aneurysm. This case illustrates a modern option to manage vascular pathology even in patients with Marfan syndrome and demonstrate how computerized fluid dynamics (CFD) vascular analysis can be used as a valuable tool to asses aortic remodeling.
Conclusion: Follow-up over 1 year showed very reassuring with complete remodeling and resolution of the aneurysm. Endovascular aortic repair with MFM stents offer an immense promise in the treatment of complex complicated TBAD due to the unique properties of these devices to stabilize the entire aortic wall without compromising the flow in the major aortic side branches.
This technique requires further evaluation, however, to assess its therapeutic potential in patients with Marfan syndrome but long-term follow-up is certainly warranted, considering the complete remodeling at 2 years follow-up.
Keywords: Marfan syndrome, aortic dissection, thoracic endovascular aortic repair, computational fluid dynamics.