title: Endovascular repair of a penetrating thoracic aortic ulcer by way of the carotid artery.
abstract: BACKGROUND
  Endovascular repair of thoracic aortic lesions offers an attractive alternative to traditional open repair. Access to the thoracic aorta can occasionally be challenging because of large device size and vessel tortuosity. Traditional access by way of the femoroiliac vessels might not be possible in the setting of synchronous iliac occlusive disease.
  
  
  METHODS
  A 63-year-old woman presented with a 7.1-cm symptomatic, penetrating ulcer of the descending thoracic aorta. The patient's severe pulmonary disease prohibited an open repair. A Talent endoprosthesis was placed under compassionate use with approval of the institutional review board. The graft was placed by way of the left common carotid artery because of severe iliac occlusive disease.
  
  
  RESULTS
  The thoracic endograft was successfully placed with exclusion of the pseudoaneurysm. The patient's chest pain resolved immediately. She developed mild left-sided weakness from a postoperative right anterior cerebral artery stroke that quickly resolved. The patient was discharged on postoperative day 5. No aortic endoleak was noted on follow-up computerized tomography scan at 1 month.
  
  
  CONCLUSIONS
  Endovascular repair should be considered in patients with thoracic aortic aneurysms, particularly those with severe medical comorbidities. Placement by way of the common carotid artery is technically feasible in the setting of synchronous aortoiliac disease.
authors.affiliation: Division of Vascular Surgery, University of Maryland Medical Center, 22 S. Green Street N4W66, Baltimore, MD 21201, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Heidenreich
authors.forename: David G
authors.initials: DG
authors.lastname: Neschis
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Costanza
authors.forename: William R
authors.initials: WR
authors.lastname: Flinn
mesh_terms: D017130:Angioplasty; D001013:Aorta, Thoracic / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002339:Carotid Arteries / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015607:Stents; D014456:Ulcer / Q000601:surgery*