Combined approach to stent-graft treatment of an aortic arch aneurysm.
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.
Buth
J
J
Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Penn
O
O
Tielbeek
A
A
Mersman
M
M
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*