RESUMO
OBJECTIVE: To analyze the natural course of asymptomatic atherosclerotic lesions of the innominate artery and to study the long-term results of surgical interventions performed at the asymptomatic stage and to compare them with similar results at the symptomatic stage of the disease. MATERIAL AND METHODS: The analysis of the natural course of the disease was performed in 74 asymptomatic patients who were divided into 3 groups depending on the initial degree of severity of the stenosis of the innominate artery: insignificant stenoses (less than 50%), moderate stenoses (50-69%) and haemodynamically significant lesions (70% and more). The analysis of the long-term results of surgical treatment was performed in 62 patients, in 29 of whom intrathoracic reconstructions were performed at the asymptomatic stage of the disease, in 33 - at the symptomatic stage. RESULTS: Cumulative freedom from stroke by the 10th year of follow-up was significantly higher in patients with insignificant stenoses and amounted to 100% in the groups of moderate stenoses and hemodynamically significant lesions - 25% and 0, respectively (log-rank p=0.000). Neurological fatality in patients with hemodynamically significant (initial or developed) lesions was 26.3%, while in patients with hemodynamically insignificant lesions it was 0 (log-rank p=0.004), which is confirmed by cumulative indices (log-rank p=0.008). Asymptomatic innominate artery reconstructions were associated with a lower incidence of stroke: the long-term incidence of stroke in such patients was 3.4%, while in initially symptomatic patients it was 18.2% (p=0.038). Initial degree II or IV cerebrovascular insufficiency was a predictor of stroke in the long-term period (OR=1.71; p=0.000). The cumulative freedom from stroke in asymptomatic patients by the 20th year of follow-up was 95% compared with 74% in symptomatic patients (log-rank p=0.032). CONCLUSION: Surgical interventions in asymptomatic hemodynamically significant lesions of the innominate artery should be performed to prevent primary cerebral circulatory disorders.
Assuntos
Aterosclerose , Tronco Braquiocefálico , Humanos , Tronco Braquiocefálico/cirurgia , Masculino , Feminino , Pessoa de Meia-Idade , Aterosclerose/cirurgia , Aterosclerose/complicações , Idoso , Doenças Assintomáticas , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/cirurgia , Resultado do Tratamento , Seguimentos , Constrição Patológica/cirurgia , AdultoRESUMO
BACKGROUND: Innominate artery aneurysms (IAAs) are rare and may result in rupture, distal arterial embolization, or local compression without timely treatment. Rupture is the most dangerous of these complications. This article reports a case of innominate artery bifurcation pseudoaneurysm. CASE PRESENTATION: The patient was a 45-year-old man who was admitted to the emergency department due to chest discomfort. The computed tomographic angiography (CTA) imaging indicated the presence of a 3.6*2.4 cm saccular aneurysm in the bifurcation of the innominate artery, involving both the right proximal subclavian and common carotid arteries. The patient's vital signs were normal, there was equal blood pressure in the upper arms and no neurological dysfunction was observed. Gadolinium-enhanced magnetic resonance angiography indicated that the circle of Willis was intact. The treatment involved open surgery combined with endovascular therapy. The external carotid artery was first transposed to the right subclavian artery (RSA) and an 8-mm woven Dacron graft was inserted in the middle. The covered stent graft was then placed in the proximal part of the innominate artery to close the entrance of the aneurysm. Lastly, an occluder was implanted at the origin of the RSA. There were no perioperative or postoperative complications. At 1-year follow-up, no aneurysm was observed on CTA and the right vertebral artery was patent. CONCLUSIONS: This study indicated that the combined use of endovascular therapy and open repair surgery is an effective strategy to treat innominate artery bifurcation pseudoaneurysm.
Assuntos
Falso Aneurisma , Implante de Prótese Vascular , Tronco Braquiocefálico , Procedimentos Endovasculares , Stents , Humanos , Masculino , Pessoa de Meia-Idade , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Tronco Braquiocefálico/diagnóstico por imagem , Tronco Braquiocefálico/cirurgia , Procedimentos Endovasculares/instrumentação , Resultado do Tratamento , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Angiografia por Tomografia Computadorizada , Angiografia por Ressonância MagnéticaRESUMO
The patient is a 56-year-old man. He fell while playing golf and sustained a contusion on his right chest. He fell into hemorrhagic shock during surgery for a right clavicle fracture at a nearby hospital and required cardiac resuscitation. Computed tomography( CT) scan revealed left pneumothorax and right hemothorax, and a contrast-enhanced CT scan revealed a pseudoaneurysm at the brachiocephalic artery origin. He underwent surgery three weeks later. Surgery was performed through a median sternotomy and partial arch replacement (zone 2) with antegrade cerebral perfusion under moderate hypothermia. He was discharged on postoperative day 10 without significant complications.
Assuntos
Falso Aneurisma , Fraturas Ósseas , Masculino , Humanos , Pessoa de Meia-Idade , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Tomografia Computadorizada por Raios X , Fraturas Ósseas/complicações , Tronco Braquiocefálico/diagnóstico por imagem , Tronco Braquiocefálico/cirurgia , PerfusãoRESUMO
OBJECTIVE: Tracheoinnominate artery fistulas (TIFs) are a rare but deadly complication of tracheostomy. Tracheoinnominate artery fistula cases in the literature were summarized in order to understand mortality associations. METHODS: MEDLINE was searched for studies reporting individual characteristics of patients with TIFs after tracheostomy, excluding cases without tracheostomy or with additional procedures at the tracheostomy site. This study followed PRISMA guidelines. RESULTS: 121 TIF patients from 18 case series and 46 case reports were included. The median age was 40 years, and 52.9% were male. The overall mortality rate was 64.5%. There were differences in mortality between cases that presented initially with vs without sentinel bleeding (odds ratio [OR] .34; CI [confidence interval] .16-.73; P = .006). The mortality rate also differed in whether or not the tracheostomy cuff was over-inflated for temporary hemostasis during resuscitation (OR 3.57 (CI 1.57-8.09); P = .002). Treatment compared to no treatment had lower mortality rates (OR .11 (CI 0.04-.32); P < .001); no differences were found if treatment was endovascular vs open surgical. CONCLUSIONS: Mortality is a major concern after detection of a TIF and resuscitation paired with endovascular or open surgical intervention is imperative. Rapidly investigating sentinel bleeds and intervening upon hemorrhage with temporary cuff over inflation may lead to improved outcomes.
Assuntos
Traqueostomia , Fístula Vascular , Humanos , Masculino , Tronco Braquiocefálico/cirurgia , Complicações Pós-Operatórias/mortalidade , Doenças da Traqueia/etiologia , Doenças da Traqueia/mortalidade , Doenças da Traqueia/cirurgia , Traqueostomia/efeitos adversos , Traqueostomia/métodos , Fístula Vascular/mortalidade , Fístula Vascular/etiologia , Fístula Vascular/cirurgiaRESUMO
The present study reported the outcomes of different treatments for innominate artery (IA) atherosclerotic stenosis or occlusion. We performed a systematic review of the literature (4 database searched; last search February 2022), including articles with ≥5 patients. We performed meta-analyses of proportions for different postoperative outcomes. Fourteen studies were included (656 patients; 396 underwent surgery, 260 endovascular procedures). IA lesions were asymptomatic in 9.6% (95% CI 4.6-14.6). Overall estimated technical success (TS) rate was 91.7% (95% CI 86.9-96.4); weighted TS rate was 86.8% (95% CI 75-98.6) in the surgical group (SG), 97.1% (95% CI 94.6-99.7) in the endovascular group (EG). Postoperative stroke in SG was 2.5% (95% CI 1-4.1) and 2.1% in EG (95% CI .3-3.8). Overall, 30-day occlusion was estimated .9% (95% CI 0-1.8) in SG and .7% (95% CI 0-1.7) in EG. Thirty-day mortality was 3.4% (95% CI .9-5.8) in SG and .7% (95% CI 0-1.7) in EG. Estimated mean follow-up after intervention was 65.5 months (95% CI 45.5-85.5) in SG and 22.4 months (95% CI 14.72-30.16) in EG. During follow-up, restenosis in SG were 2.8% (95% CI .5-5.1) and 16.6% (95% CI 5- 28.1) in EG. In conclusion, the endovascular approach seems to offer good short to mid-term outcomes, but with a higher rate of restenosis during follow-up.
Assuntos
Aterosclerose , Implante de Prótese Vascular , Procedimentos Endovasculares , Humanos , Constrição Patológica/cirurgia , Tronco Braquiocefálico/cirurgia , Aterosclerose/terapia , Resultado do Tratamento , StentsAssuntos
Artéria Pulmonar , Tetralogia de Fallot , Humanos , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Artéria Pulmonar/anormalidades , Tetralogia de Fallot/complicações , Tetralogia de Fallot/diagnóstico , Tetralogia de Fallot/cirurgia , Tronco Braquiocefálico/diagnóstico por imagem , Tronco Braquiocefálico/cirurgia , Próteses e ImplantesRESUMO
OBJECTIVE: The current report describes two rare cadaveric findings of a left sided brachiocephalic trunk (BCT) in relation to the trachea, and its high-riding course above the suprasternal notch (SN). CASES DESCRIPTION: In two elderly body donors dissected after death, a left-sided BCT was identified with a high-riding course (0.5 and 0.8 cm above the SN). The BCT originated from the aortic arch, in common with the left common carotid artery, more distally than the typical left-side location and crossed in front of the trachea. In the 1st case, the ascending and descending aortae, and the left subclavian artery had aneurysmal dilatation. In both cases, the trachea was displaced to the right side and had a stenosis due to the chronic compression. CONCLUSION: A high-riding BCT is of paramount clinical importance, as it may complicate tracheotomy, thyroid surgery and mediastinoscopy, leading to fatal complications. BCT injury leads to a massive bleeding during neck dissection (level VI), when the vessel crosses the anterior tracheal wall.
Assuntos
Aorta Torácica , Tronco Braquiocefálico , Humanos , Idoso , Tronco Braquiocefálico/cirurgia , Artéria Subclávia , Artéria Carótida Primitiva , CadáverRESUMO
Aberrant innominate artery lying high in the neck is a rare entity that can be encountered intraoperatively during midline neck surgeries such as thyroidectomy and tracheostomy. Surgeons should be mindful of this entity as injury to the artery can lead to life-threatening haemorrhage. We report a case of a 40 year old female in whom an aberrant innominate artery was identified high in the neck, while performing a total thyroidectomy.
Assuntos
Tronco Braquiocefálico , Adulto , Feminino , Humanos , Artérias , Tronco Braquiocefálico/diagnóstico por imagem , Tronco Braquiocefálico/cirurgia , Pescoço/diagnóstico por imagem , Pescoço/cirurgia , Tireoidectomia/efeitos adversosRESUMO
Blunt traumatic injuries to the brachiocephalic artery require surgical management. The operative technique used depends on the location of the injury, the patient's hemodynamic stability, and the surgeon's experience. Perfusion strategy can facilitate vascular control of the aortic arch and branch vessels. This report presents an urgent repair of a proximal posterior blunt traumatic brachiocephalic artery injury under circulatory arrest, with an excellent outcome.
Assuntos
Falso Aneurisma , Parada Cardíaca , Ferimentos não Penetrantes , Humanos , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Resultado do Tratamento , Aorta Torácica/cirurgia , Perfusão/métodos , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/etiologia , Ferimentos não Penetrantes/cirurgia , Tronco Braquiocefálico/diagnóstico por imagem , Tronco Braquiocefálico/cirurgiaRESUMO
INTRODUCTION: The aim of this study was to evaluate the efficacy and safety of innominate artery cannulation strategy with side-graft technique in proximal aortic pathologies. METHODS: A total of 70 patients underwent innominate artery cannulation with a side graft for surgery on the proximal aorta from 2012 to 2020. There were 46 men and 24 women with an average age of 56±13 years. The indications for surgery were type A aortic dissection in 17 patients (24.3%), aortic aneurysm in 52 patients (74.3%), and ascending aorta pseudoaneurysm in one patient (1.4%). The innominate artery was free of disease in all patients. Hypothermic circulatory arrest with antegrade cerebral perfusion was utilized in 60 patients (85.7%). Three patients had previous sternotomy (4.2%). The most common surgical procedure was ascending aorta with hemiarch replacement in 34 patients (48.5%). RESULTS: The mean cardiac ischemia and cardiopulmonary bypass times were 116+46 minutes and 164+56 minutes, respectively. Mean antegrade cerebral perfusion time was 27+14 minutes. The patients were cooled between 22°C and 30°C during surgery. Thirty-day mortality rate was 7.1% (five patients). One patient (1.4%) had stroke, one patient (1.4%) had temporary neurologic deficit, and eight patients (11.4%) had confusion and agitation that resolved completely in all cases. There was no local complication or arterial injury. CONCLUSION: Cannulation of the innominate artery with side graft is safe and effective for both cardiopulmonary bypass and antegrade cerebral perfusion. This technique provides satisfactory neurologic outcomes for proximal aortic surgery.
Assuntos
Dissecção Aórtica , Tronco Braquiocefálico , Masculino , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Tronco Braquiocefálico/cirurgia , Circulação Cerebrovascular , Cateterismo/métodos , Aorta/cirurgia , Dissecção Aórtica/cirurgia , Ponte Cardiopulmonar , Resultado do Tratamento , Aorta Torácica/cirurgiaRESUMO
Major injury of the innominate artery is traditionally treated with an open repair which is technically challenging, associated with large volumes of blood loss and prolonged operative times. Endovascular treatment with covered stent placement across the injury is an attractive alternative. However, placement of a single covered stent across the innominate artery bifurcation into one of its distal branches will not prevent bleeding because of retrograde perfusion from the unstented branch distal to the bifurcation. Here, we report a case of successful endovascular repair of one such injury involving the innominate artery bifurcation with ongoing extravasation into the mediastinum. The injury was successfully treated by utilizing 2 balloon-expandable covered stents placed in kissing fashion from the innominate artery into both of its distal branches. This technique of parallel covered stent placement across a bifurcation could effectively repair bifurcation injuries while maintaining patency of both distal branches.
Assuntos
Angioplastia com Balão , Tronco Braquiocefálico , Stents , Humanos , Masculino , Pessoa de Meia-Idade , Tronco Braquiocefálico/lesões , Tronco Braquiocefálico/cirurgia , Procedimentos Endovasculares , Perda Sanguínea CirúrgicaRESUMO
Isolated innominate artery injury is very rare and accounts for less than 3% of recognized arterial injuries. Surgical exploration of the artery, especially at the origin of the artery from the arch of the aorta, is surgically challenging. Due to its rarity, any 1 surgeon's experience in dealing with innominate artery injury is bound to be limited. We report 2 cases of innominate artery injury post-blunt chest trauma. Both patients underwent thoracotomy and innominate artery Dacron graft repair and both had an uneventful postoperative course.
Assuntos
Traumatismos Torácicos , Lesões do Sistema Vascular , Ferimentos não Penetrantes , Humanos , Tronco Braquiocefálico/diagnóstico por imagem , Tronco Braquiocefálico/cirurgia , Tronco Braquiocefálico/lesões , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/cirurgia , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/cirurgia , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/cirurgia , Aorta/lesõesRESUMO
We present a case of a premature infant who had an initial diagnosis of an innominate artery compression syndrome. This was approached by a median sternotomy for an aortopexy. However, the patient was found to have a distal tracheal stenosis due to a tracheal cartilage deficiency and was treated by a tracheal resection and primary anastamosis.
Assuntos
Doenças da Traqueia , Estenose Traqueal , Lactente , Humanos , Estenose Traqueal/etiologia , Estenose Traqueal/cirurgia , Estenose Traqueal/diagnóstico , Esternotomia , Tronco Braquiocefálico/cirurgia , Doenças da Traqueia/complicações , Doenças da Traqueia/diagnóstico , Traqueia/cirurgiaRESUMO
PURPOSE: The aim of this study was to assess the surgical and follow-up outcomes in children who operated for aberrant innominate artery. METHODS: A total of 15 consecutive patients (12 males, 3 females; mean age 16.3 ± 19.0 months; range 3 months to 6 years) who underwent aortopexy between February 2018 and December 2021 were evaluated. Demographic data, preoperative and postoperative clinical status and postoperative outcomes were retrospectively analyzed. RESULTS: The mean age at operation was 16.3 ± 19.0 months. The median weight was 8.3 kg (range, 7-14.5 kg).There was no complications at intraoperative period. The mean percent degree of tracheal stenosis was 0.68 ± 0.12. The median (range) MV duration, PICU stay, and ward stay of the patients were 2 h (0-3 h), 2.5 days (1-4 days), and 5 days (3-8 days), respectively. The mean patients' number of emergency service applications and hospitalization at the preoperative period was 6.2 ± 3.9/2.3 ± 1.6 and, at the postoperative period was 3.3 ± 2.2/0.9 ± 0.8. In comparison of the preoperative and postoperative service application number and hospitalization number, there was significant difference (p < 0.005 and 0.006, respectively). No reoperation was required. There was no mortality. CONCLUSION: Aberrant innominate artery is rarely seen. These pathologies misdiagnosis with different reactive airways. Following the diagnosis, treatment can be achieved by surgery successfully.
Assuntos
Tronco Braquiocefálico , Estenose Traqueal , Criança , Masculino , Feminino , Humanos , Lactente , Pré-Escolar , Tronco Braquiocefálico/cirurgia , Estudos Retrospectivos , Estenose Traqueal/cirurgia , ReoperaçãoRESUMO
BACKGROUND AND AIM OF STUDY: Transcatheter aortic valve replacement is established as the standard treatment for severe aortic stenosis. Many approaches have been described, including the suprasternal technique, an alternative for patients with unsuitable femoral arteries. We now describe a trocar-free technique for the Suprasternal approach. METHODS AND RESULTS: Under endotracheal anesthesia, an incision is made above the manubrium and dissection is carried down to the innominate artery with adequate exposure for cannulation. Access site is closed with purse-string suture. The Suprasternal approach has relatively few contraindications. CONCLUSION: Our trocar-free technique is a safe and easily reproducible technique for TAVRs in patients with poor femoral access.
Assuntos
Estenose da Valva Aórtica , Substituição da Valva Aórtica Transcateter , Humanos , Substituição da Valva Aórtica Transcateter/métodos , Estenose da Valva Aórtica/cirurgia , Artéria Femoral/cirurgia , Tronco Braquiocefálico/cirurgia , Valva Aórtica/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: Vascular involvement is an infrequent clinical manifestation of Behçet's syndrome. Owing to the rarity of arterial involvement in Behçet's syndrome, there is limited experience in managing this phenomenon. CASE PRESENTATION: Here, we report a 28-year-old Iranian man with a Behçet's syndrome background, who presented with shoulder pain and hoarseness. Chest computed tomography angiography was conducted with a suspicion of a vascular pathology causing pressure on the recurrent laryngeal nerves. The patient was diagnosed with a ruptured innominate artery pseudoaneurysm. An innominate artery to the right common carotid artery bypass was performed, and the pseudoaneurysm was excised and replaced with an expandable polytetrafluoroethylene graft. Eventually, the patient was discharged after an uneventful hospital course. CONCLUSION: It appears that we are still a long way from finding the optimal treatment for Behçet's syndrome vascular involvement, and a combination of surgical and medicinal treatments is required.
Assuntos
Falso Aneurisma , Síndrome de Behçet , Masculino , Humanos , Adulto , Tronco Braquiocefálico/cirurgia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Síndrome de Behçet/complicações , Síndrome de Behçet/diagnóstico , Síndrome de Behçet/patologia , Rouquidão/etiologia , Rouquidão/patologia , Irã (Geográfico)RESUMO
The patient was a 60-year-old woman who underwent thoracoabdominal aorta replacement for type B aortic dissection three years ago and aortic root replacement and total aortic arch replacement due to asymptomatic type A aortic dissection two years previously. Her clinical course was uneventful until follow-up computed tomography (CT) disclosed anastomotic insufficiency in the innominate artery and left main coronary artery stenosis owing to hematoma. Emergent percutaneous coronary intervention and stent graft insertion into the innominate artery were performed successfully. Seven months later, however, CT scan revealed a perforation in the posterior wall of the artificial graft damaged by the edge of the implanted stent graft. The patient underwent open surgery and perforation of artificial graft was sutured and redundant stent graft edge was resected. Artificial graft damage by stent graft placement is rare to date, but may increase in the future in accordance with broader application of endovascular treatment.
Assuntos
Aneurisma da Aorta Torácica , Dissecção Aórtica , Implante de Prótese Vascular , Procedimentos Endovasculares , Humanos , Feminino , Pessoa de Meia-Idade , Prótese Vascular , Tronco Braquiocefálico/diagnóstico por imagem , Tronco Braquiocefálico/cirurgia , Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Resultado do Tratamento , Stents , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgiaRESUMO
RATIONALE: Intraoperative innominate artery injury is life-threatening in tracheomalacia patients with prolonged tracheostomy. Anesthetic management is challenging in cases with massive hemorrhage into the endotracheal tube. We report a case in which we successfully managed a tracheomalacia patient with acute endotracheal bleeding due to innominate artery injury. PATIENT CONCERNS: A 24-year-old patient with tracheomalacia was scheduled to undergo exploratory thoracotomy for the treatment of intermittent bleeding at the tracheostomy site. During exploration, sudden active bleeding due to innominate artery injury was observed in the endotracheal lumen. DIAGNOSES: The patient was diagnosed with tracheomalacia. INTERVENTIONS: We immediately used the bronchoscope to place the tip of the endotracheal tube at the bleeding site and hyperinflated the cuff. OUTCOMES: The ballooned cuff compressed the active bleeding site, so no additional bleeding was detected by bronchoscopy, and no additional massive bleeding was observed in the operative field. LESSONS: Immediate and appropriate overinflation of the endotracheal tube cuff by an anesthesiologist may provide improved surgical field visibility and time for critical surgical procedures in cases of massive hemorrhaging.
Assuntos
Doenças da Traqueia , Traqueomalácia , Adulto , Tronco Braquiocefálico/cirurgia , Hemorragia/complicações , Hemorragia/cirurgia , Humanos , Traqueia/cirurgia , Doenças da Traqueia/complicações , Doenças da Traqueia/cirurgia , Traqueomalácia/complicações , Traqueomalácia/cirurgia , Traqueostomia/efeitos adversos , Adulto JovemRESUMO
BACKGROUND: The aim of this study was to describe a single center preliminary experience with the use of a specific balloon expandable stent-graft for the treatment of innominate artery (IA) obstructive lesions. METHODS: We report our experience with four male patients treated with Gore Viabahn balloon (Gore Medical, Flagstaff, AZ, USA) expandable stent-graft for different types of IA stenosis: three patients were symptomatic for vertebrobasilar insufficiency, while one patient was asymptomatic for cerebrovascular symptoms. The stent grafts were deployed using retrograde (N.=2) or antegrade approach (N.=2), aiming to cover the entire lesions length and to slightly protrude into the aortic arch. Post-dilatation was performed with a compliant balloon. One patient presented a tandem lesion (IA and right internal carotid artery) and after the stenting of the IA he was treated also with a carotid artery stenting during the same procedure. RESULTS: Technical success was achieved in all patients. No perioperative or postoperative complications had been reported and the neurological disorders disappeared for the three symptomatic patients. After a mean clinical and radiological follow-up of 24±5 months, all the stents were patent and perfectly adapted to the vessels. CONCLUSIONS: This preliminary clinical experience shows that the use of the Gore Viabahn balloon (Gore Medical) expandable stent-graft seems safe and feasible for the treatment of the IA obstructive lesions, also in presence of irregular plaques and hostile anatomies for an endovascular treatment. Larger experiences and long-term data are mandatory.