Endovascular repair of a ruptured descending thoracic aortic aneurysm

Abstract

Endovascular aneurysm repair has considerable potential advantages over the surgical approach as a treatment for thoracic aortic rupture, in part because open surgical repair of ruptured thoracic aortic aneurysms is associated with high mortality and morbidity rates. We describe the successful endovascular deployment of stent-grafts to repair a contained rupture of a descending thoracic aortic aneurysm in an 86-year-old man whose comorbidities prohibited surgery. Two months after the procedure, magnetic resonance angiography showed a patent stent-graft, a patent left subclavian artery, and complete exclusion of the aneurysm.

Fig. 1 A chest radiograph taken in the emergency department of another hospital shows almost complete obliteration of the left lung.

Fig. 2 Contrast-enhanced computed tomography shows a 5.2-cm thoracic aneurysm (arrow) and a large hematoma in the left lower hemithorax.

Fig. 3 Three-dimensional magnetic resonance angiography shows the saccular aneurysm on the undersurface of the thoracic arch.

Fig. 4 A) After the proximal aortic cuff was deployed, the stent-graft was post-dilated with a premounted balloon contained in the stent-graft system. B) Two more aortic cuffs (arrows) were deployed sequentially, with at least 1.5 cm of overlap.

Fig. 5 Follow-up angiography shows a patent left subclavian artery (arrowhead) and exclusion of the aneurysm without leakage into the sac.

Fig. 6 Follow-up magnetic resonance angiography shows that the left subclavian artery (arrowhead) remains patent and the stent-graft is well opposed to the aortic wall.