Abstract
Open surgical rerouting and proximal ligation of one or more supra-aortic vessels prior to endovascular stent-graft placement has become an alternative to major open thoracic surgery in the treatment of complex thoracic aortic disease. Complications owing to failed surgical ligation of the left subclavian artery are rare. In this report, 3 cases of failed ligation are presented. Diagnosis was made by CT-scan and treatment was performed by transcatheter coil and plug embolization, avoiding redo neck surgery.
Highlights
Endovascular repair has become a valuable alternative to open repair for the treatment of several thoracic aortic pathologies [1,2,3,4]
In this report we present the clinical and radiological outcome after endovascular management of failed surgical ligation of the left subclavian artery during supraaortic rerouting for safe thoracic stent-graft placement
It was decided to exclude the thoracic aneurysm with use of a stent-graft (Valiant, Medtronic, Santa Clara, CA, USA) after placing a carotidosubclavian bypass and ligation of the proximal left subclavian artery in order to minimize potential postoperative neurological symptoms related to myelum ischemia
Summary
Endovascular repair has become a valuable alternative to open repair for the treatment of several thoracic aortic pathologies [1,2,3,4]. It was decided to exclude the thoracic aneurysm with use of a stent-graft (Valiant, Medtronic, Santa Clara, CA, USA) after placing a carotidosubclavian bypass and ligation of the proximal left subclavian artery in order to minimize potential postoperative neurological symptoms related to myelum ischemia. Control CT-scan 6 months later revealed discrete increase of the aneurismal sac diameter up to 69 mm owing to a type II endoleak by retrograde sac perfusion through the incompletely ligated proximal left subclavian artery. Control CT-scan 9 months later revealed a completely excluded thoracic aortic aneurysm without endoleak and stable in diameter. Follow-up CT-scan revealed a growing thoracic arch aneurysm and a type II endoleak by retrograde perfusion of the aneurysmal sac through an incompletely ligated left subclavian artery (Figure 6).
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