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. 2018 Jul;30(3):254-259.
doi: 10.1016/j.jsha.2017.10.002. Epub 2017 Oct 21.

Endovascular repair of a leaking aortic-arch pseudoaneurysm using graft stent combined with chimney protection to left common carotid artery: Case report and review of literature

Raneem Fallatah  1   2 , Abdelfatah A Elasfar  1   3 , Shadha Alzubaidi  1 , Mazen Alraddadi  4 , Reda Abuelatta  1
Affiliations

Endovascular repair of a leaking aortic-arch pseudoaneurysm using graft stent combined with chimney protection to left common carotid artery: Case report and review of literature

Raneem Fallatah et al. J Saudi Heart Assoc. 2018 Jul.

Abstract

Aortic pseudoaneurysm (PsA) is a rare but serious condition that has high mortality and morbidity rates if untreated. We report a rare case of leaking aortic-arch PsA repaired by thoracic endovascular aortic repair using graft stent with the chimney technique to protect the left common carotid artery. Unlike other cases in the literature, our case was unique, having leaking PsA not related to previous cardiac surgery or aortic dissection. The successful management of this patient using thoracic endovascular aortic repair combined with the chimney technique suggests that this approach may be an attractive therapeutic alternative to treat aortic-arch PsA.

Keywords: Aortic-arch pseudoaneurysm; Thoracic endovascular aortic repair.

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Figures

Figure 1
Figure 1
Preoperative chest X-ray and CTA: (A) chest X-ray showing widening of the mediastinum with left upper zone opacity (arrow); (B) and (C) initial CTA demonstrated saccular aortic-arch PsA with contrast tracking; (D) repeated CTA showing a minimal to mild interval increase in PsA size and contrast tracking. Ao = aorta; CTA = computed tomography aortogram; Lt. PA = left pulmonary artery; PsA = pseudoaneurysm.
Figure 2
Figure 2
Thoracic angiography: (A) showing a PsA was evident at the proximal descending aorta arising at the level of the left subclavian artery from the left lateral aspect of the aortic arch; (B) and (C) stent-graft deployment with near-total coverage of the LCCA and the left subclavian artery; (D) retrograde chimney stenting to the LCCA through transcarotid approach; no evidence of endoleak and patent LCCA. Ao = aorta; BC = brachiocephalic; LCCA = left common carotid artery; Lt. CCA = left common carotid; PsA = pseudoaneurysm.
Figure 3
Figure 3
Postoperative CTA: (A) and (B) confirm the excellent exclusion of the aortic-arch PsA, no significant endoleak, and the patency of both aorta and LCCA. CTA = computed tomography aortogram; LCCA = left common carotid artery; PsA = pseudoaneurysm.
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