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Introduction: Distal tears are an important issue after thoracic endovascular aortic repair as they directly affect thrombosis in the false lumen. However, it is difficult to treat distal tears in clinical practice due to the potential complications that may occur.Case report: We report the case of a 58-year-old male patient who received a GORE C-TAG stent placement by means of a “triple periscope technique” (a stent graph was placed in the superior mesenteric artery (SMA) and the bilateral renal artery). Post-CTA imaging three months later indicated that the distal dissecting aortic aneurysm was successfully isolated, and the three abdominal branches were well-perfused, interestingly the celiac branch with well–perfusion via collateral circulation pathway between the celiac trunk and the superior mesenteric artery.Conclusions: The periscope technique used in this report for reconstructing the branch vessel involved in the dissecting aneurysm was easy to learn and operate. Combined with another skill that initial deployment in the distal segment of stent-graft, distal entry tear of aortic dissecting aneurysm could be ensured with accurate coverage, as well as well-perfusion in the abdominal branches.

Objectives: A low false lumen thrombosis rate (FLTR) is common in patients with type B aortic dissection after they have undergone thoracic endovascular aortic repair, which indicates a poor long-term prognosis. This study aimed to establish a quantitative linear regression model to predict false lumen (FL) thrombosis accurately using morphological parameters., Methods: In this retrospective study, we included 59 patients diagnosed with acute type B aortic dissection between 2014 and 2017. Morphological parameters were measured. Univariable and multivariable linear regression analyses were performed, and a linear regression model relating FLTR with the number of re-entry tears was proposed. Ten patients were further chosen to validate the linear relationship, and idealized aortic dissection models were adopted for haemodynamic analysis., Results: Only the total area and number of re-entry tears were negatively correlated with FL thrombosis (P < 0.001). Moreover, based on the univariable regression, the number of re-entry tears played a more crucial role in FLTR (R2 = 0.509 vs R2 = 0.298), and the linear relationship model was created as follows: thrombosis rate (%) = -11.25 × distal tear number + 105.24. This model was perfectly matched in 10 patients (concordance correlation coefficient = 0.880, P = 0.947). Moreover, when the total area of re-entry tears was constant, the net blood flow increased rapidly with an increase in the tear count., Conclusions: The number of re-entry tears could be a crucial related factor of FL thrombosis; the larger the number of re-entry tears is, the lower the possibility of thrombosis is., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)