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Case Reports
. 2016;9(3):228-231.
doi: 10.3400/avd.cr.16-00011. Epub 2016 Aug 9.

A Case of Tandem Plug Embolization for an Aberrant Right Subclavian Artery during Debranching Thoracic Endovascular Aortic Repair

Tatsushi Onzuka  1 , Yasuhisa Oishi  2 , Hikaru Uchiyama  1 , Yoshie Ochiai  1 , Atsuhiro Nakashima  1 , Kenji Shinozaki  3
Affiliations
Case Reports

A Case of Tandem Plug Embolization for an Aberrant Right Subclavian Artery during Debranching Thoracic Endovascular Aortic Repair

Tatsushi Onzuka et al. Ann Vasc Dis. 2016.

Abstract

Aberrant right subclavian artery embolization is problematic in debranching thoracic endovascular aortic repair, because concomitant bypass grafting to the right upper arm may hinder complete embolization. We report a case of a thoracic aortic aneurysm with aberrant right subclavian artery successfully treated with debranching thoracic endovascular aortic repair and bypass grafting. Although endoleakage was found from aberrant right subclavian artery after single use of Amplatzer vascular plug, additional deployment of Amplatzer vascular plug II completely eliminated residual endoleakage. This simple technique is useful for the aberrant right subclavian artery embolization in debranching thoracic endovascular aortic repair.

Keywords: TEVAR; aberrant subclavian artery; amplatzer vascular plug.

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Figures

Fig. 1
Fig. 1. CT images of the thoracic aorta (A) before surgery, (B) after debranching TEVAR and bypass grafting, and (C) at discharge. (A) The ARSA arose from the right side of the proximal descending TAA and ran toward the opposite side of the aortic arch. (B) The AVP was inserted into the ARSA. The stent-graft that ran along the greater curvature could not fill the ARSA ostium. An endoleak was observed through the AVP into the TAA. (C) An AVP II was additionally inserted into the ARSA. The tandem AVPs eliminated the residual endoleakage and ensured complete embolism between the ARSA and aneurysm. CT: computed tomography; TAA: thoracic aortic aneurysm; TEVAR: thoracic endovascular aortic repair; ARSA: aberrant right subclavian artery; TB: truncus bicaroticus; LSA: left subclavian artery; SG: stent-graft; AVP: Amplatzer vascular plug; EL: endoleak
Fig. 2
Fig. 2. Three-dimensional reconstructed CT (A) before surgery and (B) at discharge. Left and right images are from the left anterior oblique and right posterior oblique views, respectively. (A) A proximal descending TAA with an arch vessel anomaly was seen. (B) The TAA and proximal ARSA were excluded from the systemic blood flow after debranching TEVAR and ARSA embolization. Cerebral blood flow was maintained by bypass grafting from the left carotid artery to the bilateral axillary arteries. CT: computed tomography; TAA: thoracic aortic aneurysm; TEVAR: thoracic endovascular aortic repair; ARSA: aberrant right subclavian artery; TB: truncus bicaroticus; LSA: left subclavian artery
Fig. 3
Fig. 3. Angiography after the additional AVP II insertion. The AVP and AVP II were inserted into ARSA in a tandem manner. ARSA: aberrant right subclavian artery; LSA: left subclavian artery; SG: stent-graft; AVP: amplatzer vascular plug
See this image and copyright information in PMC

References

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