CASE REPORT Endovascular Aneurysm Repair Using a Reverse Chimney Technique in a Patient With Marfan Syndrome and Contained Ruptured Chronic Type B Dissection Dominik Ketelsen • Guenay Kalender • Martin Heuschmid • Roland Syha • Stefanie Mangold • Claus D. Claussen • Klaus Brechtel Received: 11 October 2010 / Accepted: 12 January 2011 / Published online: 9 February 2011 Ó Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2011 Abstract We report endovascular thoracic and abdomi- nal aneurysm repair (EVAR) with reverse chimney tech- nique in a patient with contained ruptured type B dissection. EVAR seems feasible as a bailout option in Marfan patients with acute life-threatening disease. Keywords Arterial intervention Á Endovascular aneurysm repair/endovascular aortic repair (EVAR) Á Endovascular treatment Á Thoracicendovascular aortic repair (TEVAR) Á Aorta Á Kidney/renal Á Abdominal aortic aneurysms (AAA) Á Aneurysms Introduction Marfan syndrome is a systemic disorder of the connective tissue. The most life-threatening manifestations are aortic aneurysm and dissection in early adulthood. Surgical treatment options, e.g., aortic root replacement, have sub- stantially improved the life expectancy of patients with Marfan syndrome and have led to an increased cohort of patients with aortic disease of the descending aorta [1, 2]. Endovascular aortic aneurysm repair is a well-established technique in non-Marfan patients with type B dissection. Nevertheless, several reports have shown promising results of primary procedural success even in patients with Marfan syndrome [1–5]. Case Report A 69-year-old male patient with known Marfan syndrome presented in the emergency department with increasing abdominal pain for the previous 5 days. The patient had undergone elective aortic root and valve replacement (15 years previous); surgical treatment (2–10 years previ- ous) of aneurysms of the left internal iliac artery, both common femoral arteries, and the left deep femoral artery; and multiple hernia surgeries. Because of known chronic type B dissection with perfused false lumen of the descending aorta (initial diagnosis 19 years previous), computed tomography angiography (CTA) was performed initially. CTA showed a size-increasing type B dissection with a maximum diameter of 7.6 cm (increased in diameter from 5.2 cm compared with CTA taken 9 months previously). At the thoracoabdominal junction, CTA depicted soft tissue adjacent to the aorta, which is suspicious for hematoma outside the aortic lumen. Therefore, CTA appearance was highly suspicious for a contained aortic rupture at the site of the false lumen with a visible juxtarenal intimal tear (Fig. 1). A thoracic entry tear was not seen on CTA. The aortic dissection ranged from the thoracic descending aorta to the abdominal aorta approximately 3 cm below the renal arteries. The celiac trunk, the superior mesenteric artery, and the left renal artery were perfused by way of the true lumen and the right renal artery by way of the false lumen. There was no evidence of malperfusion of the abdominal organs. D. Ketelsen and G. Kalender contributed equally to this work. D. Ketelsen Á M. Heuschmid Á R. Syha Á S. Mangold Á C. D. Claussen Á K. Brechtel (&) Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, 72076 Tuebingen, Germany e-mail: klaus.brechtel@med.uni-tuebingen.de G. Kalender Department of Thoracic and Cardiovascular Surgery, Eberhard-Karls-University, 72076 Tuebingen, Germany 123 Cardiovasc Intervent Radiol (2011) 34:1080–1084 DOI 10.1007/s00270-011-0106-1