Thorac Cardiovasc Surg 2005; 53(5): 322-324
DOI: 10.1055/s-2005-865630
Short Communication

© Georg Thieme Verlag KG Stuttgart · New York

Successful Type II Endoleak Closure by Subclavian-to-Carotid Artery Transposition After Stent-Graft Placement of a Distal Aortic Arch Aneurysm

D. Zimpfer1 , M. Schoder2 , T. Fleck1 , T. Holzenbein1 , M. Cejna2 , J. Lammer2 , E. Wolner1 , M. Grabenwoger1 , M. Czerny1
  • 1Department of Cardiothoracic Surgery, University of Vienna Medical School, Vienna, Austria
  • 2Department of Interventional Radiology, University of Vienna Medical School, Vienna, Austria
Further Information

Publication History

Received February 3, 2005

Publication Date:
06 October 2005 (online)

Abstract

Endovascular stent-graft placement has become a safe and effective treatment modality for various diseases of the distal aortic arch as well as of the descending aorta [[1], [2], [3], [4], [5]]. However, its effectiveness may be limited by various kinds of endoleaks resulting in persistent or recurrent perfusion of the aneurysm sac [[6], [7]]. Subsequently, systemic pressurization leads to expansion of the aneurysm sac, exposing the patient to a recurrent risk of aneurysm rupture. We report on the case of a 57-year-old male who underwent emergency stent-graft placement in March 2001 due to a contained rupture of a distal aortic arch aneurysm involving the origin of the left subclavian artery. Due to the emergency condition, a subclavian-to-carotid artery transposition had not been performed prior to stent-graft placement. During follow-up the patient developed a type II endoleak originating from the left subclavian artery with consecutive enlargement of the aneurysm sac. The endoleak was successfully treated by subclavian-to-carotid artery transposition.

References

  • 1 Dake M D, Kato N, Mitchell R S. et al . Endovascular stent-graft placement for the treatment of acute aortic dissection.  N Engl J Med. 1999;  340 1546-1552
  • 2 Nienaber C A, Fattori R, Lund G. et al . Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement.  N Engl J Med. 1999;  340 1539-1545
  • 3 Czerny M, Fleck T, Zimpfer D. et al . Combined repair of an aortic arch aneurysm by sequential transposition of the supraaortic branches and consecutive endovascular stent-graft placement.  J Thorac Cardiovasc Surg. 2003;  126 930-932
  • 4 Hutschala D, Fleck T, Czerny M. et al . Endoluminal stent-graft placement in patients with acute aortic dissection type B.  Eur J Cardiothorac Surg. 2002;  21 964-969
  • 5 Schoder M, Grabenwoger M, Holzenbein T. et al . Endovascular stent-graft repair of complicated penetrating atherosclerotic ulcers of the descending thoracic aorta.  J Vasc Surg. 2002;  36 720-726
  • 6 Schoder M, Cartes-Zumelzu F, Grabenwoger M. et al . Elective endovascular stent-graft repair of atherosclerotic thoracic aortic aneurysms: clinical results and midterm follow-up.  Am J Roentgenol. 2003;  180 709-715
  • 7 Faries P L, Cadot H, Agarwal G, Kent C, Hollier L H, Marin M L. Management of endoleak after endovascular aneurysm repair: cuffs, coils, and conversion.  J Vasc Surg. 2003;  37 1155-1161
  • 8 Kato N, Dake M D, Miller D C. et al . Traumatic thoracic aortic aneurysm: treatment with endovascular stent-grafts.  Radiology. 1997;  205 657-662
  • 9 Walker S R, Macierewicz J, Hopkinson B R. Endovascular AAA repair: prevention of side branch endoleaks with thrombogenic sponge.  J Endovasc Surg. 1999;  6 350-353
  • 10 Vogt P R, Brunner-La Rocca H P, Carrel T. et al . Cryopreserved vascular allograft in the treatment of major vascular infection: a comparison with conventional surgical techniques.  J Thorac Cardiovasc Surg. 1998;  116 965-972
  • 11 Criado F J, Barnatan M F, Rizk Y, Clark N S, Wang C. Technical strategies to expand stent-graft applicability in the aortic arch and proximal descending thoracic aorta.  J Endovasc Ther. 2002;  9 II32-II38
  • 12 Buth J, Penn O, Tielbeek A, Mersman M. Combined approach to stent-graft treatment of an aortic arch aneurysm.  J Endovasc Surg. 1998;  5 329-332
  • 13 Iguro Y, Arata K, Yamamoto H, Masuda H, Sakata R. A new concept in distal arch aneurysm repair with a stent graft.  J Thorac Cardiovasc Surg. 2002;  123 378-380
  • 14 Okada K, Sueda T, Orihashi K, Watari M, Ishii O. An alternative procedure of endovascular stent-graft repair for distal arch aortic aneurysm involving arch vessels.  J Thorac Cardiovasc Surg. 2001;  121 182-184

Dr. Daniel Zimpfer

Waehringer Guertel 18 - 20

1090 Vienna

Austria

Phone: + 431404005643

Fax: + 43 14 04 00 56 42

Email: Daniel.Zimpfer@meduniwien.ac.at