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October 17, 2008
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Alexander M Tummers*, Mike Lebow, Scott Stevens
University of Tennessee Knoxville, Knoxville, TN
Background: When combined with arch anomalies, thoracic aortic aneurysm repair(TAA) can prove challenging. We describe the treatment of a 62 year old female with a right sided aortic arch, a Kommerel's diverticulum, and a descending thoracic aortic aneurysm with contained rupture.
Methods: Workup included MRI angiogram and CT angiogram with 3D reconstruction These 3D studies were reviewed for endograft sizing and pre-case planning. Considering this patient's particular anomaly of right sided arch with an aberrant left subclavian artery takeoff and a Kommerel’s diverticulum, we formulated a strategy for endovascular repair, as open repair would have required bilateral thoracotomies. The diverticulum was first embolized with an Amplatzer plug to avoid a type 2 endoleak. Next, the endograft was delivered endovascularly through a right femoral artery access.
Results: Immediate exclusion of the leaking TAA was confirmed. With the left subclavian artery embolized, retrograde flow via the vertebral artery to the left upper extremity was visualized. Follow up CT scan at one month demonstrated resolution of the contained rupture.
Conclusions: To the best of our knowledge, this represents the first report using this combination of endovascular strategies and preoperative 3D imaging for repairing a ruptured TAA. Advances in 3D imaging, improved embolization tools, and innovation in graft technology coupled with improved clinical judgement and skillsets have allowed us to extend our reach in treating complex aortic pathology.
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Endovascular Repair of Ruptured Thoracic Aortic Aneurysm with Right Sided Aortic Arch
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Alexander M Tummers*, Mike Lebow, Scott Stevens
University of Tennessee Knoxville, Knoxville, TN
Background: When combined with arch anomalies, thoracic aortic aneurysm repair(TAA) can prove challenging. We describe the treatment of a 62 year old female with a right sided aortic arch, a Kommerel's diverticulum, and a descending thoracic aortic aneurysm with contained rupture.
Methods: Workup included MRI angiogram and CT angiogram with 3D reconstruction These 3D studies were reviewed for endograft sizing and pre-case planning. Considering this patient's particular anomaly of right sided arch with an aberrant left subclavian artery takeoff and a Kommerel’s diverticulum, we formulated a strategy for endovascular repair, as open repair would have required bilateral thoracotomies. The diverticulum was first embolized with an Amplatzer plug to avoid a type 2 endoleak. Next, the endograft was delivered endovascularly through a right femoral artery access.
Results: Immediate exclusion of the leaking TAA was confirmed. With the left subclavian artery embolized, retrograde flow via the vertebral artery to the left upper extremity was visualized. Follow up CT scan at one month demonstrated resolution of the contained rupture.
Conclusions: To the best of our knowledge, this represents the first report using this combination of endovascular strategies and preoperative 3D imaging for repairing a ruptured TAA. Advances in 3D imaging, improved embolization tools, and innovation in graft technology coupled with improved clinical judgement and skillsets have allowed us to extend our reach in treating complex aortic pathology.
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