Aortic Stent Graft Exclusion of Dissecting Thoracic Aneurysm

- Operator :

Aortic Stent Graft Exclusion of Dissecting Thoracic Aneurysm
- Operator: Anupam Goel, MD
Clinical presentation
A 60-year old woman presented with severe anemia, and cachexia with complaints of hoarseness of voice and difficulty in swallowing for 1 month. She also presented with hemoptysis and melena for 3 days. Her CT angiography of thoracic aorta revealed Pseudo-aneurysm of aortic arch dissecting into tracheal lumen and esophagus.
Procedure
Aortic Arch Angiogram was done using 5F Pigtail from left femoral artery. (Figure 1, Figure 2, Figure 3). Right femoral arteriotomy was performed and Amplatz Extra stiff guide wire was placed in ascending thoracic aorta with 12F Reliant Stent Graft Balloon Catheter (Figure 4, Figure 5). After repeat arch angiogram and measurements, Medtronic Talent 34 x 130mm Stent Graft was positioned just distal to left common carotid artery origin (Figure 6, Figure 7, Figure 8). In view of the arch position of the aneurysm, the positioning of the stent graft was technically challenging. The positions of proximal and distal marker were confirmed with arch angiogram and stent graft released at the position covering the aneurysm and post dilated with Medtronic Reliant 40 x 46mm balloon (Figure 9). Repeat angiogram showed no flow in the aneurysm (Figure 10, Figure 11, Figure 12).
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