{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T21:40:33Z","timestamp":1773265233755,"version":"3.50.1"},"reference-count":5,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>Persistent false lumen perfusion of the remaining dissected aorta after open or endovascular aortic repair remains a major determinant of late aneurysmal growth and reintervention, often driven by complex and sometimes unexpected haemodynamic mechanisms. This case involves a 77-year-old man with progressive false lumen enlargement following staged hybrid repair of a chronic type A aortic dissection. Despite apparently successful gutter embolisation around a Candy Plug, intraoperative transoesophageal echocardiography (TEE) revealed persistent false lumen flow. Careful TEE assessment identified an unexpected proximal intercostal artery as the source of reperfusion. Selective catheterisation and coil embolisation of this artery were successfully performed under combined TEE and fusion imaging guidance, achieving immediate and durable exclusion. This case highlights the unique value of intraoperative TEE as a real-time haemodynamic imaging tool that can detect endoleaks missed by angiography and directly guide therapeutic decision-making in complex aortic dissections.<\/jats:p>","DOI":"10.3389\/fcvm.2026.1755914","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T05:35:58Z","timestamp":1773207358000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Focusing on the unexpected: decision-making and embolisation of an unexpected intercostal artery guided by intraoperative transoesophageal echocardiography in persistent thoracic aortic false lumen perfusion and growth"],"prefix":"10.3389","volume":"13","author":[{"given":"Audrey","family":"Mouche","sequence":"first","affiliation":[{"name":"Department of Vascular and Cardiac Surgery, l\u2019Institut du Thorax, CHU Nantes, Nantes University","place":["Nantes, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laurent","family":"Brisard","sequence":"additional","affiliation":[{"name":"Anesthesia and Critical Care Department, CHU Nantes","place":["Nantes, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Blandine","family":"Maurel","sequence":"additional","affiliation":[{"name":"Department of Vascular and Cardiac Surgery, l\u2019Institut du Thorax, CHU Nantes, Nantes University","place":["Nantes, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2873","DOI":"10.1093\/eurheartj\/ehu281","article-title":"2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European Society of Cardiology (ESC)","volume":"35","author":"Erbel","year":"2014","journal-title":"Eur Heart J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1846","DOI":"10.1161\/CIRCULATIONAHA.117.031264","article-title":"Insights from the international registry of acute aortic dissection: a 20-year experience of collaborative clinical research","volume":"137","author":"Evangelista","year":"2018","journal-title":"Circulation"},{"key":"B3","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1177\/1526602816640523","article-title":"Candy-plug technique using an excluder aortic extender for distal occlusion of a large false lumen aneurysm in chronic aortic dissection","volume":"23","author":"Ogawa","year":"2016","journal-title":"J Endovasc Ther"},{"key":"B4","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1177\/1526602817709252","article-title":"The candy-plug technique: technical aspects and early results of a new endovascular method for false lumen occlusion in chronic aortic dissection","volume":"24","author":"Rohlffs","year":"2017","journal-title":"J Endovasc Ther"},{"key":"B5","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1067\/mtc.2000.108904","article-title":"Primary endoleakage in endovascular treatment of the thoracic aorta: importance of intraoperative transesophageal echocardiography","volume":"120","author":"Fattori","year":"2000","journal-title":"J Thor Cardiovasc Surg"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1755914\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T05:35:59Z","timestamp":1773207359000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1755914\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,11]]},"references-count":5,"alternative-id":["10.3389\/fcvm.2026.1755914"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1755914","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,11]]},"article-number":"1755914"}}