A 74 year old gentleman presented with history of hoarseness of voice for last 3 months. He consulted many physicians which led to a CT chest. The CT scan revealed a 2 X 1 cm aneurysm arising from the inner curvature of the arch. the site of the aneurysm was 2cm distal to the origin of the left subclavian artery. On investigation the patient was also diagnosed to have chronic renal failure with a serum creatinine of 2.4. His cardiac evaluation was normal. The site of the aneurysm was ideal for an endovascular procedure. The age and CRFalso pushed the decision towards an endovascular repair.
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| CT Aortogram Showing saccular aortic arch aneurysm with surrounding hematoma. |
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| CT Aortogram images showing the location of the aneurysm. |
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| Diagram showing stent placement. |
The patient underwent a successful aneurysm repair using a Gore thoracic endovascular graft. In ths procedure a covered stent of appropriate size is positioned inside the aorta thus occluding the neck of the aneurysm. The approach is through the femoral artery. He was discharged the next day.
Three months post-op the patients hoarseness has improved remarkably. The CT aortogram shows a well placed stent with complete isolation of the aneurysmal sac.
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| Post op CT Aortogram |
Comment- Aneurysms of the aortic arch are a difficult subset to manage. Conventional surgery requires median sternotomy/thoracotomy with cardio-pulmonary bypass with deep circulatory arrest. The procedure is high risk with prolonged stay in the hospital. In the recent years, endovascular grafting is becoming the procedure of choice for these patients. The patient can be discharged in a day or two and can resume normal activities.
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