Manejo endovascular de hemoptisis secundaria a pseudoaneurisma de la aorta torácica, mediante un abordaje proximal

Objetivo: Describir un caso clínico y una alternativa de manejo para el tratamiento de la hemoptisis secundaria a patología la aneurismática de la aorta torácica. Materiales y Métodos: Revisión de historia clínica y exámenes complementarios, disponibles en sistema digital del centro asistencial de origen. Resultados: Se presenta el caso de paciente masculino, 56 años, que cursó con cuadro de hemoptisis, posteriormente objetivado como secundario a un pseudoaneurisma de la aorta torácica. Entre sus antecedentes destaca, enfermedad aorto-ilíaca tratada mediante un bypass de aorta torácica. Se decidió la reparación endovascular, mediante un abordaje proximal, utilizando la arteria axilar. Discusión: Las indicaciones para el uso de la reparación torácica endovascular de la aorta (TEVAR) se están expandiendo ampliamente, incluyendo a pacientes previamente intervenidos o aquellos que antiguamente se consideraban con un riesgo prohibitivamente alto para una cirugía. La fístula aorto-bronquial, es una complicación rara, sin embargo, existe correlación entre su desarrollo y la cirugía de aorta torácica. La sospecha diagnóstica debe ser alta. La AngioTC, cumple un doble rol, tanto para el diagnóstico, como para la planificación preoperatoria, hecho fundamental para conseguir una terapia adecuada.

Objective: To describe a clinical case and a management alternative for the treatment of hemoptysis secondary to thoracic aortic aneurysm pathology. Material and Method: Review of clinical history and complementary examinations, available in the digital system of the health care center of origin. Results: We present the case of a male patient, 56 years old, presented with hemoptysis, later found to be secondary to a pseudoaneurysm of the thoracic aorta. History included aorto-iliac disease treated by thoracic aortic bypass. Endovascular repair was decided by a proximal approach using the axillary artery. Discussion: Indications for the use of TEVAR are expanding widely. Including previously operated patients or those formerly considered prohibitively high risk for surgery. Aortobronchial fistula is a rare complication, however, there is a correlation between its development and thoracic aortic surgery. Diagnostic suspicion should be high. AngioCT plays a dual role in diagnosis and preoperative planning, which is essential to achieve adequate therapy.

A Case of Survival after Thoracic Endovascular Aortic Repair for Descending Thoracic Aortic Aneurysm Rupture and Aortoesophageal Fistula without Esophagectomy / 日本心臓血管外科学会雑誌

The patient was an 82-year-old woman. For dysphagia scrutiny, upper gastrointestinal endoscopy and biopsy of a submucosal tumor of the midthoracic esophagus were performed. The patient was urgently admitted to the Department of Gastroenterology for examination and treatment. After admission, enhanced CT showed a descending thoracic aortic aneurysm (DTA) pressing on the esophagus. On the third day of hospitalization, the patient suffered massive hematemesis and went into shock, and emergency thoracic endovascular aortic repair (TEVAR) was performed with resuscitation based on the diagnosis of esophageal perforation of the DTA. The patient was weaned from the ventilator by tracheotomy without cerebrospinal complications and left the intensive care unit on the seventh postoperative day. One month after surgery, a CT scan showed that the DTA had almost disappeared and that the esophageal compression had been released. The patient was managed with antibacterial therapy and nutritional support other than oral intake and was discharged home 7 months after surgery without stent graft infection or mediastinitis. The usefulness of TEVAR for ruptured descending thoracic aortic aneurysms has been reported in many cases. However, in patients with an aortoesophageal fistula (AEF), esophagectomy is required after TEVAR to control infection, and the mortality rate of this disease is high. We report a case in which infection were controlled by antibacterial therapy and nutritional management other than oral intake after TEVAR and the patient survived.

Placement of an Open Stent Graft for Treatment of a Distal Aortic Arch Aneurysm and Migrated Stent Graft Nine Years after TEVAR for Stanford Type B Dissection / 日本心臓血管外科学会雑誌

A 76-year-old man who underwent thoracic endovascular aortic repair (TEVAR) of an early chronic phase of Stanford type B dissection developed a 71 mm distal aortic arch aneurysm in conjunction with the migration of its proximal end over 9 years of follow-up. The proximal end of the graft had migrated 7 cm distal to the takeoff of the left subclavian artery. The patient underwent total arch replacement with an open stent graft which was connected with the TEVAR graft. He was discharged home 15 days after surgery without complications.

Debranching Thoracic Endovascular Aortic Repair for Kommerell's Diverticulum with Right-Sided Aortic Arch / 日本心臓血管外科学会雑誌

We report a case of debranching thoracic endovascular aortic repair for Kommerell's diverticulum with right-sided aortic arch in 78-year-old women. The computed tomography (CT) demonstrated Kommerell's diverticulum with a right-sided aortic arch and the trachea and esophagus were compressed by the diverticulum. The diverticulum had a maximum diameter of 32 mm, and surgical intervention was chosen because of the aneurysmal change and the possibility of rupture. We performed endovascular aortic repair for Kommerell's diverticulum with a right-sided aortic arch because of low lung function and low frailty. The patient was discharged on the 21st postoperative day. There was no evidence of aortic event during 2 years follow up.

Two Cases of Successful Treatment of Percutaneous Transarterial Embolization via Costocervical Trunk Approach for Patients with Persistent Type II Endoleak and Sac Enlargement of Arch Aneurysm after Thoracic Endovascular Aortic Repair (TEVAR) / 日本心臓血管外科学会雑誌

Among the less reported complications after thoracic endovascular aortic repair (TEVAR) is type II endoleak (T2EL). The intercostal and bronchial artery are known as feeder vessels to T2EL after TEVAR. We experienced two cases of successful treatment of percutaneous transarterial feeder vessels embolization via right costocervical trunk approach for patients with persistent T2EL and sac enlargement of an arch aneurysm after TEVAR. The costocervical trunk route is possible for key vessels to construct a collateral pathway to feeder vessels of the endoleak nidus of T2EL after TEVAR procedures for aortic arch aneurysm. A preembolizational Catheter-Directed CT angiogram (CTA) can be helpful to prevent harmful complications (e.g., spinal cord infarction).

Thoracic Endovascular Aortic Repair for Chronic Aortic Dissection with an Isolated Left Vertebral Artery / 日本心臓血管外科学会雑誌

Thoracic endovascular aortic repair (TEVAR) is valuable in the treatment of type B aortic dissection. An isolated left vertebral artery (ILVA) is a common anomaly of the aortic arch. The ILVA is covered during TEVAR in specific cases; however, whether the ILVA should be reconstructed in all cases remains controversial. We report a case of TEVAR performed for chronic aortic dissection in a patient with an ILVA. A 57-year-old woman with an ILVA had a type B acute aortic dissection one year prior to presentation and underwent TEVAR owing to dilation of an ulcer-like projection. We performed ILVA-left common carotid artery (LCCA) anastomosis and LCCA-left axillary artery bypass prior to TEVAR using our usual procedure. The postoperative course was favorable without any major complication. ILVA reconstruction may reduce the incidence of postoperative stroke and spinal cord injury. Usually, an ILVA is easily accessible through the supraclavicular approach, and the anatomical position of the vessel facilitates ILVA-LCCA anastomosis. ILVA reconstruction requires additional features and further consideration.

Surgical Strategy for Protecting Major Branch Arteries during Thoracic Endovascular Aortic Repair for Shaggy Descending Aortic Aneurysms / 日本心臓血管外科学会雑誌

Surgery for a shaggy aortic aneurysm requires a meticulous strategy to prevent embolic complications since the complications are associated with longer length of hospital stay and higher mortality. However, until now, there are no established treatment options to prevent embolic complications. We report a case of a 75-year-old man with a descending aortic aneurysm and a shaggy aorta who underwent thoracic endovascular aortic repair (TEVAR) with major branch artery protection. During the procedure, we placed balloon catheters in the left subclavian and left common iliac arteries, a filter device in the superior mesenteric artery, and a sheath at the ostium of the right common iliac artery. The patient did not develop embolic or other complications and was discharged on the eighth postoperative day. Our strategy of using the balloon occlusion technique and filter placement at the major vessels effectively prevented embolic complications during TEVAR for a shaggy aorta.

A Case of Staged Hybrid Repair for a Distal Aortic Arch Aneurysm with Shaggy Aorta / 日本心臓血管外科学会雑誌

We report on a case of a distal aortic arch aneurysm with severe shaggy aorta treated by two-stage hybrid surgery without complications. The patient was a 67-year-old man. The thoracic aortic aneurysm was identified on computed tomography imaging by his treating physician during routine follow-up for lung cancer. The patient was referred to our hospital for further investigation and treatment. The aneurysm had a maximum diameter of 68 mm with severe shaggy aorta. Based on these findings, the risk of cerebral infarction and spinal cord ischemia was considered very high. The patient underwent total arch replacement with elephant trunk, using a brain isolation technique for this initial surgery. The postoperative course was uneventful and thoracic endovascular aortic repair（TEVAR) was performed 26 days after the initial surgery. The patient was discharged on post-operative day 38, without complications.

A Case of Successful TEVAR for Acute Stanford Type A Aortic Dissection with a Thrombosed False Lumen / 日本心臓血管外科学会雑誌

In acute Stanford type A aortic dissection, except for some thrombosed false-lumen types, graft replacement is a standard treatment. On the other hand, thoracic endovascular aortic repair (TEVAR) might be considered for high-risk patients with retrograde type A aortic dissection when entry is in the descending aorta, although its efficacy in a case of an extensive thrombosed false lumen without obvious entry is unknown. We report a case of successful zone 3 TEVAR using RelayPro NBS for Stanford type A aortic dissection with a localized CT-enhanced false lumen in the proximal descending aorta. An 83-year-old woman was admitted for acute Stanford type A aortic dissection with a thrombosed false lumen of the ascending thoracic aorta. She was initially treated conservatively because of being a high-risk patient for open surgery. One week after hospitalization, the ascending aorta diameter increased and the false lumen in the proximal descending aorta grew sporadically in a CT image. We suspected that the ascending aorta was enlarged due to a partially patent false lumen of the descending thoracic aorta, and performed zone 3 TEVAR using RelayPro NBS to close a possible entry in the proximal descending aorta even though there was no obvious entry. The patient had a good postoperative course and was discharged 15 days after TEVAR. Shrinkage of the false lumen in the ascending aorta was observed in CT images two months after TEVAR.

Disección aórtica Stanford tipo B no complicada tratada con reparación aórtica endovascular / Stanford Type B Uncomplicated Aortic Dissection Treated with Endovascular Aortic Repair

Resumen La disección aórtica aguda es una urgencia médica asociada a una alta mortalidad, por lo que es fundamental el diagnóstico precoz a partir de una historia clínica detallada, hallazgos a la exploración física y estudios de imagenología, pilares fundamentales para su diagnóstico. El tratamiento depende de su localización, con recomendación de abordaje quirúrgico urgente para las disecciones agudas de tipo A y principalmente el tratamiento farmacológico en la disección aórtica tipo B no complicada. Presentamos el caso de un paciente del sexo masculino, de origen mexicano, que desarrolló disección aórtica tipo B no complicada, a quien se decidió abordar con tratamiento farmacológico y reparación aórtica endovascular, y presentó una adecuada evolución del cuadro clínico, sin complicaciones al egreso ni durante su seguimiento.

Abstract Acute aortic dissection is a medical emergency associated with high mortality, so an early diagnosis based on a detailed clinical history, physical examination findings, and imaging studies is essential for its diagnosis. The treatment depends on its location, with the recommendation of an urgent surgical approach for acute type A dissections and mainly pharmacological treatment in uncomplicated type B aortic dissection. We present the case of a Mexican male patient who developed uncomplicated type B aortic dissection, that was treated with pharmacological treatment and endovascular aortic repair, and presented an adequate clinical evolution without complications at discharge or during follow-up.

Hemodynamic Analysis of Redissection after Endovascular Repair for One Stanford Type B Aortic Dissection Case / 医用生物力学

Objective Based on hemodynamic analysis, to investigate the cause of distal re-entry tear in Stanford type B aortic dissection after thoracic endovascular aortic repair (TEVAR).Methods A patient with type B aortic dissection was reexamined regularly with computed tomography angiography (CTA) at 1st month, 6th month, 12th month and 24th month after TEVAR. Based on the CTA images in each period, three-dimensional (3D) aorta models were reconstructed to perform morphological analysis and hemodynamic simulation.Results Compared with the diameter at 1st month after TEVAR, the diameter of true lumen at 12 months after TEVAR increased by 1.8 times and the global distortion of aorta increased by 16.67%. At postoperative 1st, 6th and 12th month, the maximum blood velocities at the new entry tear in systole were 69.6%, 33.7% and 92.1% higher than the average ones at distal landing zone, and the maximum wall shear stresses (WSSs) were 2.52, 2.32 and 3.52 times of the average WSSs respectively. In addition, the maximum time-averaged WSS (TAWSS) at 1st, 6th and 12th month after TEVAR were 1.88, 2.53 and 3.62 times of the mean TAWSS respectively.ConclusionsThe morphology of the aorta remodeled after TEVAR, and a sudden change in the diameter of true lumen occurred at distal anchoring zone and continued to increase. As a result, the blood flow velocity in this area accelerated, and the intima was continuously exposed to high WSS, leading to the redissection.

A Case of Thoracic Endovascular Aortic Repair for Subacute Aortic Dissection Stanford Type B in a Patient with Marfan Syndrome / 日本心臓血管外科学会雑誌

A 41-years-old man with Marfan syndrome developed acute aortic dissection Stanford Type B. A new entry was located at the distal aortic arch. Medical treatment was given for a month, but the proximal descending aorta expanded to 50 mm. Because he had undergone partial arch replacement at the age of 36, thoracic endovascular aortic repair (TEVAR) using the synthetic graft as proximal landing zone was performed to close the entry. Six months after TEVAR, the false lumen around the stent graft disappeared. Distal stent graft-induced new entry (d-SINE) did not occur after TEVAR. Three years after TEVAR, we performed thoracoabdominal aortic replacement because of expansion of the residual false lumen without any complication. Endovascular therapy could be useful option for extensive aortic lesion even in Marfan syndrome.

Reparación endovascular de la aorta torácica, resultados a largo plazo / Endovascular repair of the thoracic aorta, long-term results

Resumen Introducción: Las diversas patologías de la aorta torácica descendente, representan una implícita amenaza para la vida, y son potencialmente tratables mediante reparación endovascular. Objetivo: Evaluar los resultados de la reparación endovascular de la aorta torácia descendente (TEVAR). Material y Método: Estudio observacional, retrospectivo y descriptivo, donde se analiza TEVAR, en un período de 10 años (2009 al 2019), en el Hospital Dr. Eduardo Pereira de Valparaíso, Chile. Resultados: Se realizó TEVAR en 31 pacientes, sexo masculino 74,2%, femenino 25,8%, edad promedio 67,8 años (rango 53-85), patologías asociadas: hipertensión arterial sistémica (77,4%), tabaquismo (67,7%) y dislipidemia (38,7%), las indicaciones para TEVAR fueron: el aneurisma de la aorta descendente (51,61%), la disección tipo B crónica complicada (29,03%), y la disección tipo B aguda complicada (19,35%), relacionado al procedimiento se evidenció: morbilidad cardiovascular (12,9%) y morbilidad neurológica (6,45%), complicaciones relacionadas a la endoprótesis (29,03%), incidencia de endofugas (19,35%), estancia hospitalaria promedio de 5,2 días (rango 3 a 17), seguimiento promedio de 47,3 meses (9-108), éxito técnico primario (100%), tasa de reintervención: 3,22%, tasa de supervivencia a 1, 3, 5 años del 96,77%, 93,54 y 90,32% respectivamente, no hubo mortalidad menor a 30 días. Discusión: La evidencia demuestra que TEVAR puede realizarse en forma segura y efectiva, cumpliendo estrictos criterios clínicos y condiciones anatómicas, representando la modalidad de elección para la reparación de las lesiones de la aorta descendente. Conclusión: Los resultados demuestran que TEVAR, representa una excelente estrategia terapeutica, menos invasiva, con baja morbilidad y mortalidad asociada.

Introduction: The pathological injuries of the descending thoracic aorta, represent an implicit threat to life, and are potentially treatable by endovascular repair. Aim: To evaluate the results of endovascular repair of the descending thoracic aorta (TEVAR) in the medium and long term. Material and Method: Observational, retrospective and descriptive study, where TEVAR is analyzed, over a period of 10 years (2009 to 2019), at the Dr. Eduardo Pereira Hospital in Valparaíso, Chile. Results: TEVAR was performed in 31 patients, male sex 74.2%, average age 67.8 years (range 53-85), symptomatic 64.5%, associated pathologies: systemic arterial hypertension (77.4%), smoking (67.7%) and dyslipidemia (38.7%), indications for endovascular repair were descending aortic aneurysm (51.61%), complicated Stanford type B chronic aortic dissection (29.03%), and complicated Stanford type B acute aortic dissection (19.35%), neurological morbidity (6.45%), cardiovascular morbidity (12.9%), complications related to the stent (29.03%), where endoleaks predominate (19.35%), average hospital stay of 5.2 days (range 3 to 17), average followup of 47.3 months (9-108), primary technical success (100%), survival rate at 1, 3, 5 years of 96.77%, 93.54 and 90.32% respectively, there was no mortality less than 30 days or reoperation. Discussion: the evidence shows that TEVAR can be performed safely and effectively, meeting strict clinical criteria and anatomical conditions, which represents the modality of choice for the repair of lesions in the descending aorta. Conclusion: The results show that TEVAR represents an excellent therapeutic strategy, less invasive, with low associated morbidity and mortality.

Hybrid Approach to Complex Stanford Type B Dissection: Unusual Extra-anatomical Bypass (Aorto-Celiac-Mesenteric Bypass) + Thoracic Endovascular Aortic Repair (TEVAR) + Cholecystectomy

Abstract Patients with complex Stanford type B aortic dissection are very difficult to treat. Many methods have been proposed so far in the treatment of these patients, and the emergence of hybrid techniques has made the treatment easier. In this article, we shared the extra-anatomical bypass (aorto-celiac-mesenteric bypass) + thoracic endovascular aortic repair + cholecystectomy operation technique applied to a patient with complex type B aortic dissection.

Open Repair versus Endovascular Repair of Blunt Traumatic Thoracic Aortic Injuries : Short- and Mid-Term Outcomes / 日本心臓血管外科学会雑誌

Objective : The mainstream strategy for blunt traumatic thoracic aortic injuries (BTAI) has been shifting from conventional open repair (OR) to thoracic endovascular aortic repair (TEVAR). Accordingly, we reviewed the short- and mid-term outcomes following surgical procedures of BTAI, comparing OR with TEVAR. Methods : We retrospectively collected data of consecutive cases of BTAI in a single institution from March 2001 to August 2019. Results : Eighteen cases were identified. Of these, 7 patients (38.9%, mean age 62.0±15.2 years) were treated with OR and 11 (61.1%, mean age 61.8±21.3 years) were treated with TEVAR. There was significant reduction in the mean operative duration (OR 444±145 vs TEVAR 65±14 min ; p＜0.001), the mean intraoperative blood loss (OR 2,787±1,578 vs TEVAR 210±376 ml ; p＜0.001), the volume of blood transfusions (OR 5,042±2,219 vs TEVAR 929±751 ml ; p＜0.001), and the mean dose of heparin infusion (OR 20.3±4.1 vs TEVAR 7.9±8.5 ml ; p＜0.01). Postoperative 30-day mortality of OR and TEVAR were 28.6 and 0% (p＝0.14), respectively. There was no endoleak, 1 case of paraparesis, and 1 case of bilateral cerebellar infarction in the TEVAR group. There was no significant difference in the length of stay in the intensive care unit, the duration of hospital stay, the rate of home discharge, or the mid-term mortality and re-intervention rate (average follow-up period of 42.0±56.9 months). Conclusions : Compared with OR, TEVAR took less operative time with less bleeding, and required less blood transfusions and heparin. The short- and mid-term outcomes following TEVAR for BTAI was favorable and TEVAR appears to be applicable as a first-line treatment for BTAI.

A Case of Staged Hybrid Repair for Subacute Type B Aortic Dissection in a Patient with Shaggy Aorta / 日本心臓血管外科学会雑誌

In aortic surgery involving shaggy aorta, surgical strategy to avoid embolism is crucial for each case. We applied the frozen elephant trunk technique to a patient with shaggy aorta. A 79-year-old man was admitted to our hospital for conservative treatment of acute Type B aortic dissection. Dissecting aneurysms of the aortic arch and descending aorta were shown to have rapidly dilated according to CT three weeks later. Preoperative contrast CT showed an ulcerated shaggy aorta from the aortic arch to the mid portion of the descending aorta. To utilize the benefit of the stent compared with the classical elephant trunk technique, we proposed that the frozen elephant trunk technique would be helpful in prevention of embolism. We therefore planned total arch replacement with the frozen elephant trunk technique and performed thoracic endovascular aortic repair. We employed the frozen elephant trunk technique in the first operation and balloon protection of the superior mesenteric artery and the renal artery in the second operation. The patient had an uneventful postoperative course without thromboembolism. The frozen elephant trunk technique may be helpful for patients with shaggy aorta to avoid thromboembolic events.

Stent Graft Implantation into a False Lumen of a Chronic Type B Aortic Dissection after Surgical Abdominal Aortic Fenestration / 日本心臓血管外科学会雑誌

A 57-year-old man, who had suffered chest, back and right leg pain about 10 years before, underwent CT and was found a chronic type B aortic dissection with an enlarged false lumen and a narrowed true lumen that was occluded at the infrarenal abdominal aorta. A conventional surgical repair seemed to be too high risk considering his comorbidities, thus we chose a staged hybrid repair. First, surgical repair of the abdominal aorta with an abdominal aortic fenestration was performed. Then, one month after the first operation, zone 2 thoracic endovascular aortic repair with left carotid-axillary artery bypass was performed. At the second operation, the stent graft was purposely deployed from zone 2 into Th12 level of a false lumen through the fenestration followed by coil embolization of a true lumen just distal to the entry tear. The postoperative course was uneventful and he had no complications at 6 months follow-up. Deploying stent graft into a false lumen could be a feasible option in case deploying into a true lumen is not suitable if the anatomical condition permits.

Arc of Buhler: A lifesaving anatomic variation. A case report / Arco de Buhler: uma variação anatômica que salva vidas - relato de caso

Abstract The presence of malperfusion syndrome in cases of complicated acute type B aortic dissection is a negative predictive factor and urgent intervention is indicated. Anatomic variations, such as the Arc of Buhler, contribute anastomotic channels and can preserve the visceral blood supply. In this case report, we describe the overall management of a 54-year-old man who presented with a type B aortic dissection. Initially, conservative management was chosen, as indicated for an uncomplicated type B dissection, but the dissection deteriorated. Despite the fact that severe occlusion of the celiac artery was detected on Computed Tomography (CT) angiography, the Arc of Buhler anatomical variation was present, contributing adequate visceral blood supply. After considering this finding, the patient was treated effectively with thoracic endovascular aortic repair (TEVAR).

Resumo A presença da síndrome de má perfusão em casos de dissecção aórtica aguda do tipo B complicada é um fator preditor negativo, e uma intervenção urgente é indicada. As variações anatômicas, tais como o arco de Buhler, contribuem como canais anastomóticos e podem preservar o suprimento sanguíneo visceral. Neste relato de caso, descrevemos o manejo geral de um paciente do sexo masculino, de 54 anos, que apresentou uma dissecção aórtica do tipo B. Inicialmente, o manejo conservador foi escolhido, conforme indicado para dissecção do tipo B não complicada, mas a dissecção sofreu deterioração. Apesar de uma oclusão grave da artéria celíaca ter sido detectada na angiotomografia computadorizada, a variação anatômica do arco de Buhler estava presente, contribuindo para o suprimento sanguíneo visceral adequado. Após levar em consideração esse achado, o paciente foi tratado de forma efetiva com reparação endovascular da aorta torácica.

Endovascular repair combined with fenestrated stent grafts in treating aortic arch lesions / 中华胸心血管外科杂志

Objective@#To evaluate endovascular repair combined with fenestrated stent grafts for the treatment of aortic dissection or aneurysm involving aortic arch.@*Methods@#From Jun 2017 to Dec 2018, 30 patients of complicated aortic arch lesions were treated with endovascular repair combined with fenestrated endografts. 26 male and 4 female, aged(53±16) years. All patients had hypertension. 12 cases were treated via needle based in situ fenestration, another 16 cases using physician modified stent grafts, while 2 cases combining these two methods to achieve optimal fenestration. Patients were followed by receiving CTA for mortality, patency of bridging stents, endoleaks and complications.@*Results@#Operations were performed successfully in all cases. The median follow-up is 8.5 months. There was no aorta-related mortality. 1 patient developed cerebral infarction and 1 had hydropericardium. Type Ⅲ endoleaks were observed in 5 patients, no reintervention. All target vessels were patent during the follow up.@*Conclusion@#Fenestrated stent grafts shows satisfactory short-term outcomes in treating aortic arch lesions.

A Case Report after Two Years of Total Debranching and Endovascular Repair for Kommerell Diverticulum / 日本心臓血管外科学会雑誌

A 78-year-old woman with abnormal shadows on computed tomography (CT) was given a diagnosis of right-sided aortic arch and Kommerell diverticulum (KD), accompanied by aberrant left subclavian artery. Although no symptoms were observed, the maximum diameter of the aneurysm was 63 mm, and surgical intervention was chosen because of the possibility of rupture. At first, a 4-branched blood vessel prosthesis with a side branch was anastomosed to the ascending aorta. Next, after reconstructing the cervical branches, a Conformable GORE® TAG® (W.L. Gore and Associates, 34 mm×200 mm) was inserted from the side branch and expanded in the range of Zones 0 to Th 7. Finally, ALSA coil embolization was performed. She was discharged on postoperative day 36, and at her 2-year follow-up, she was doing well, with shrinkage of Kommerell diverticulum.