Modified Double-Fenestrated Stent Graft for Branched Thoracic Endovascular Aortic Repair of an Irregular Aortic Arch Aneurysm: A Case Report

Abstract

A 43-year-old male was admitted to General Hospital of Northern Theater Command with exacerbation of chest pain for 10 d. Computed tomographic angiography (CTA) showed an irregular aortic arch aneurysm involving the left subclavian artery (LSA), with penetrating aortic ulcer and intramural hematoma. A modified fenestrated thoracic endovascular aortic repair (TEVAR) technique was performed successfully. Follow-up CTA showed that stent grafts were well-apposed, without endoleaks, migration, or branch artery occlusion, and the hematoma was almost completely absorbed. In this case, precise fenestrations were created by measurements based on three-dimensional CT reconstruction and angiography. Furthermore, the physician chose an LSA approach to catch the guide wire and deployed branched stent grafts, considering the oblique direction of this branch and the small size of the fenestration. This case shows that pre-fenestrated and inner bare stent enhancing TEVAR is a safe and feasible technique for repair of complicated aortic arch aneurysm.