Treatment of an Aortic Arch Aneurysm with Scalloped and Fenestrated Thoracic Stent Graft and Left Carotid to Subclavian Artery Bypass.
We report a successful treatment of thoracic arch aneurysm using a combination of hybrid approach and a customized stent graft in a frail patient with challenging anatomy and concomitant large retrosternal goiter. The patient is an 82-year-old lady with multiple comorbidities who presented to her general practitioner for anorexia and significant weight loss. She was incidentally found to have a 6.6-cm saccular distal aortic arch aneurysm, a 5.5-cm infrarenal abdominal aortic aneurysm, and a large goiter adjacent to the left common carotid artery (CCA) with retrosternal extension. The arch aneurysm was successfully managed with an open left common carotid to left subclavian bypass followed by thoracic endovascular aneurysm repair (EVAR) with a Cook stent graft customized to the patient's anatomy incorporating a proximal scallop for the brachiocephalic artery and a fenestration for the left CCA, and Amplatzer plug for occlusion of the ostium of the left subclavian artery. There was no endoleak and she was discharged uneventfully. She is planned for staged EVAR of her abdominal aortic aneurysm at a later date. In the presence of difficult arch aneurysm anatomies, the hybrid approach with bespoke stent grafts is a feasible alternative to open aortic arch replacement.
University of Sydney Medical School, Sydney, NSW, Australia; Department of Vascular Surgery, Singapore General Hospital, Singapore, Singapore.
Cheow Soon
CS
Chia
Department of Vascular Surgery, Singapore General Hospital, Singapore, Singapore.
Luke Hsien Tsung
LHT
Tay
Department of Vascular Surgery, Singapore General Hospital, Singapore, Singapore.
John Chaw Chian
JCC
Wang
Department of Vascular Surgery, Singapore General Hospital, Singapore, Singapore.
Tze Tec
TT
Chong
Department of Interventional Radiology, Singapore General Hospital, Singapore, Singapore.
Kiang Hiong
KH
Tay
Department of Vascular Surgery, Singapore General Hospital, Singapore, Singapore. Electronic address: edward.choke.t.c@singhealth.com.sg.
Edward Tieng Chek
ETC
Choke
D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D017536:Carotid Artery, Common / Q000601:surgery*; D000072226:Computed Tomography Angiography; D005260:Female; D016330:Frail Elderly; D006801:Humans; D033162:Incidental Findings; D011474:Prosthesis Design; D015607:Stents; D013348:Subclavian Artery / Q000601:surgery*; D016896:Treatment Outcome