title: Aortic arch and descending thoracic aortic saccular aneurysms treatment with fenestrated endograft and chimney technique for aortic branch rescue.
abstract: We report the case of a 76-year-old man presented with three saccular aneurysms at the aortic arch and descending thoracic aorta. A two-staged hybrid approach was performed. A left common carotid-to-left subclavian artery bypass and a custom-made fenestrated endograft were used for the two proximal aneurysms. The endograft deployment was complicated by the unadverted coverage of the left common carotid artery ostium, promptly corrected with the chimney technique. The endovascular treatment was completed with the third endovascular aneurysm exclusion 5 months after the first procedure to reduce the risk of spinal cord ischemia. Yearly follow-up computed tomography scan confirmed aortic arch and descending thoracic aorta aneurysms exclusion with supra-aortic vessels, bypass, and stent patency. Endovascular repair of the aortic arch aneurysm with a fenestrated endograft is safe and feasible in selected patients. Complications may be solved with total endovascular approach. Long term follow-up remains mandatory.
authors.affiliation: Vascular Surgery Unit, Department of Surgery, "San Francesco" Hospital, Nuoro, Italy; Vascular Surgery Unit, Department "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy. Electronic address: kasemiholta@libero.it.
authors.forename: Holta
authors.initials: H
authors.lastname: Kasemi
authors.affiliation: Vascular Surgery Unit, Department of Surgery, "San Francesco" Hospital, Nuoro, Italy; Vascular Surgery Unit, Department "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Marino
authors.affiliation: Vascular Surgery Unit, Department of Surgery, "San Francesco" Hospital, Nuoro, Italy.
authors.forename: Costantino Luca
authors.initials: CL
authors.lastname: Di Angelo
authors.affiliation: Vascular Surgery Unit, Department of Surgery, "San Francesco" Hospital, Nuoro, Italy; Vascular Surgery Unit, Department "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Fadda
authors.affiliation: Vascular Surgery Unit, Department "Paride Stefanini", Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Speziale
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency