title: Endovascular repair of a ruptured subclavian artery aneurysm in a patient with Ehlers-Danlos syndrome using a sandwich technique.
abstract: We present the case of a type IV Ehlers-Danlos syndrome patient with a ruptured right subclavian artery aneurysm and associated arteriovenous fistula who underwent successful endovascular repair requiring simultaneous stent graft repair of the innominate artery using a sandwich technique. A 17-year-old man with known type IV Ehlers-Danlos syndrome developed right neck and shoulder swelling. CTA study demonstrated a 17 × 13-cm ruptured subclavian artery aneurysm with an associated internal jugular vein arteriovenous fistula. In the hybrid suite, a 7 mm × 15-cm stent graft (Viabahn, WL Gore & Associates, Flagstaff, AZ) was advanced from the right brachial approach into the innominate artery. A separate wire was placed into the right carotid artery via the right femoral approach (7 Fr), and a 7 mm × 10-cm stent graft (Viabahn) was advanced into the innominate artery. An additional 8 mm × 10-cm stent graft (Viabahn) was placed from the right brachial approach to obtain a distal-landing zone in the axillary artery. Complex vascular anatomy, in which graft seal creation may be challenging, does not exclude endovascular approaches as the sandwich technique can be utilized as a suitable alternative to open repair.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, TX.
authors.forename: Sapan S
authors.initials: SS
authors.lastname: Desai
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, TX.
authors.forename: Maria
authors.initials: M
authors.lastname: Codreanu
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, TX.
authors.forename: Kristofer M
authors.initials: KM
authors.lastname: Charlton-Ouw
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, TX.
authors.forename: Hazim
authors.initials: H
authors.lastname: Safi
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, TX ali.azizzadeh@uth.tmc.edu.
authors.forename: Ali
authors.initials: A
authors.lastname: Azizzadeh
mesh_terms: D000293:Adolescent; D017542:Aneurysm, Ruptured / Q000209:etiology / Q000601:surgery*; D001164:Arteriovenous Fistula / Q000601:surgery; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D004535:Ehlers-Danlos Syndrome / Q000150:complications*; D057510:Endovascular Procedures; D006801:Humans; D008297:Male; D015607:Stents; D013348:Subclavian Artery
keywords: Ehlers–Danlos syndrome; endovascular approaches; endovascular repair; sandwich technique