PMC6023716_01
(a) Initial computed tomography (CT) scan showing main part of the aneurysm in descending aorta, arrow points to perforation. (b) Aneurysm of the ascending aorta after 1 year. Arrow points to localized dilatation. (c) Result: Outer diameter of the aneurysm started to recede. Arrows show proximal and distal anastomosis of the celiac trunk bypass.
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A computed tomography (CT) led to the diagnosis of a covered ventral aortic perforation of the descending thoracic aorta approximately 5 cm above the diaphragm ( Fig. 1 ).   After 1 year, an aneurysm of the ascending aorta showed an increase in diameter of 1 cm reaching 5.6 cm in total extending to the landing zone of the first TEVAR ( Fig. 1 ).
(a) Before procedure. (b) After the first procedure. Arrow shows endoleak. (c) Final result after three procedures and aortoceliac bypass. No enhancement of contrast medium. Thrombus is solid, total exclusion of aneurysm.
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Postinterventional CT scan showed a small endoleak initially understood as type II ( Fig. 2 ). 