PMC3898389_01
CTA demonstrated an aortic arch with 50 mm sized saccular aneurysm at 3 mm distal to the LCCA, aortic arch coarctation in the size of 12 mm (A, B), and a LICA aneurysm (C). DSA was in agreement with the CTA images (D) and showed patency of the carotid to carotid bypass (E); Brachial-femoral stretch guidewire technique was performed (F); The completion aortogram revealed no evidence of endoleak; disappearance of the aortic arch aneurysm lumen (G).
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F1
The CTA also showed a 50 mm sized saccular aneurysm 3 mm distal to the left common carotid artery (LCCA), the left subclavian artery (LSA) arose from the aortic arch aneurysm and the size of aortic arch coarctation was 12 mm (Figure 1A-C). It also confirmed the patency of the carotid to carotid bypass graft and showed dominant right vertebral artery (Figure 1D, E). Therefore, the right brachial artery was punctured and cannulated with a 6-French catheter sheath from which a snare (AMPLATZ GOOSE NECK, ev3 Inc., USA) was inserted into the ascending aortic artery to capture the Lunderquist super stiff guidewire (brachial-femoral stretch guidewire) (Figure 1F). The completion aortogram revealed no evidence of endoleak; disappearance of the aortic arch aneurysm lumen and patency of the carotid to carotid bypass (Figure 1G).
CTA demonstrated aortic arch aneurysm sac with thrombosis and a small endoleak, and patent carotid to carotid bypass in one week follow-up (A, B). Postoperative CTA demonstrated thrombosis in the aneurysm lumen, no endoleak and the aortic arch and the carotid to carotid bypass were all patent except very mild stenosis of LICA at 8-month follow-up (C, D, E).
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F2
His postoperative course was uneventful and discharged on postoperative day 7 with a follow-up CTA demonstrating aortic arch aneurysm sac thrombosis with a little type I endoleak and patent carotid to carotid bypass (Figure 2A, B). The aortic arch and the carotid to carotid bypass were both patent except very mild stenosis of LICA and aortic arch (Figure 2C, D, E).