title: Combined approach to stent-graft treatment of an aortic arch aneurysm.
abstract: OBJECTIVE
  To report the first use of dual brachiocephalic vessel transposition from the aortic arch prior to endovascular exclusion of an arch aneurysm.
  
  
  RESULTS
  Patch graft repair of a saccular aortic arch aneurysm in a 74-year-old woman failed to exclude the lesion, resulting in aneurysm enlargement. Because the patient was debilitated, a combined open and endovascular procedure was performed in which the common carotid and subclavian arteries were transposed prior to successful insertion of a Vanguard aortic stent-graft to exclude the aneurysm. Imaging 1 and 6 months after the combined procedure demonstrated complete thrombosis of the aneurysm.
  
  
  CONCLUSIONS
  Transposition from the aortic arch of one or more brachiocephalic vessels may allow stent-graft exclusion of aortic arch aneurysms. However, the durability of thoracic aortic endografts must be ascertained before the indications for their use are expanded.
authors.affiliation: Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Buth
authors.forename: O
authors.initials: O
authors.lastname: Penn
authors.forename: A
authors.initials: A
authors.lastname: Tielbeek
authors.forename: M
authors.initials: M
authors.lastname: Mersman
mesh_terms: D000368:Aged; D000792:Angiography; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D017536:Carotid Artery, Common / Q000601:surgery*; D005260:Female; D006801:Humans; D015607:Stents; D013348:Subclavian Artery / Q000601:surgery*