Acute debranching and stent grafting for a ruptured penetrating ulcer of the aortic arch.
BACKGROUND
We report a hybrid treatment for a ruptured penetrating aortic ulcer (PAU) of the aortic arch in emergency conditions.


METHODS
A 74-year-old man with severe comorbidity was diagnosed with a symptomatic rupture of a PAU of the aortic arch. As he was considered unfit for conventional open repair and it was an emergency condition, an acute endovascular repair with cervical debranching of the supra-aortic trunks could be proposed. The left common carotid artery and left subclavian artery were first debranched and revascularized through cervical access, and the endovascular stent graft was then deployed via femoral access in the aortic arch. At >or=2 years the patient is safe with no sign of progression of the disease.


CONCLUSIONS
Acute debranching and stent grafting is feasible in emergency conditions to treat ruptured PAU of the aortic arch, with satisfying short- and mid-term outcomes, and can be proposed to patients considered unfit for conventional open repair.
Alsac
Jean-Marc
JM
Service de Chirurgie Thoracique et Vasculaire, Hôpital Bichat-Claude Bernard, AP-HP, Faculté Diderot, Paris VII, Paris, France. jmalsac@hotmail.com
Coscas
Raphaël
R
Paraskevas
Nikolaos
N
Francis
Fady
F
Castier
Yves
Y
Leseche
Guy
G
D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D017536:Carotid Artery, Common / Q000601:surgery; D006801:Humans; D008297:Male; D015607:Stents; D013348:Subclavian Artery / Q000601:surgery; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome; D014456:Ulcer / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*