Abstract
Aortic arch aneurysm is a rare condition but carries a high risk of rupture. We report one case of aortic arch aneurysm combined with aortic arch coarctation and left internal carotid artery aneurysm, which is extremely rare. Left internal carotid artery aneurysm resection and revascularization, carotid and carotid graft bypass combined with endovascular stent graft and embolization with coils were successfully performed. There were no any complaints and complications at 8 months follow-up. The follow-up CTA demonstrated thrombus formation in the aneurysm lumen, no endoleak and the aortic arch and bypass graft were all patent. We feel that hybrid procedure may be a valuable therapeutic alternative when treating this type of lesion. However, long-term clinical efficacy and safety have yet to be confirmed.
Highlights
Aortic arch aneurysm is a rare condition but carries a high risk of rupture
Previous reports that we have identified in English literature included conventional surgical repair, hybrid surgery and embolization of an aortic arch aneurysm with detachable coils [1,2,3,4,5]
We report one case of aortic arch aneurysm combined with aortic arch coarctation and left internal carotid artery (LICA) aneurysm, which is extremely rare
Summary
Aortic arch aneurysm is a rare condition but carries a high risk of rupture. Previous reports that we have identified in English literature included conventional surgical repair, hybrid surgery and embolization of an aortic arch aneurysm with detachable coils [1,2,3,4,5]. We report one case of aortic arch aneurysm combined with aortic arch coarctation and left internal carotid artery (LICA) aneurysm, which is extremely rare. The patient had immediate relief of coarctation, with residual gradient decreasing from 38 mmHg to 7 mmHg. the left brachial artery was punctured and cannulated with a 6-French catheter sheath from which a 5 F vertebral catheter was inserted into the aortic arch aneurysm via a 0.035 inch guidewire, and four 15 mm coils were placed into the aortic arch aneurysm sac. Systemic heparinization was administrated during the procedure 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)
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