J Korean Med Sci.  2011 Mar;26(3):444-446. 10.3346/jkms.2011.26.3.444.

Hybrid Endovascular Repair of Thoracic Aortic Aneurysm in a Patient with Behcet's Disease Following Right to Left Carotid-carotid Bypass Grafting

• Hong S
• Park HK
• Shim WH
• Youn YN

• KMID: 2157885
• DOI: http://doi.org/10.3346/jkms.2011.26.3.444

Abstract

Endovascular repair of inflammatory aortic aneurysms has been reported as an alternative to open surgical treatment. In selective cases, adjunctive bypass surgery may be required to provide an adequate landing zone. We report a case of endovascular repair of an inflammatory aortic aneurysm in a patient with Behcet's disease using a carotid-carotid bypass graft to provide an adequate landing zone. A 45-yr-old man with a voice change was referred to our hospital with the diagnosis of saccular aneurysm of the distal aortic arch resulting from vasculitis. Computed tomography showed a thoracic aortic aneurysm with thrombosis. Right to left carotid-carotid bypass grafting was performed. After 8 days, the patient underwent an endovascular stent graft placement distal to the origin of the innominate artery. The patient was discharged with medication and without postoperative complications after 5 days. Hybrid endovascular treatment may be suitable a complementary modality for repairing inflammatory aortic aneurysms.

Keyword

Endovascular Repair; Aortic Aneurysm; Inflammatory; Carotid-Carotid Bypass; Behcet Syndrome

MeSH Terms

Aortic Aneurysm, Thoracic/complications/radiography/*surgery
Behcet Syndrome/*complications/surgery
Blood Vessel Prosthesis Implantation/*methods
Carotid Arteries/physiopathology/*surgery
Coronary Artery Bypass
Endovascular Procedures
Humans
Male
Middle Aged
Stents
Thrombosis/complications
Tomography Scanners, X-Ray Computed
Vasculitis/complications

Figure

• 

  Fig. 1 Preoperative computed tomography and aortogram. (A) Computed tomography scan shows a saccular aneurysm on the distal aortic arch. (B) An aortogram shows obstruction of the left subclavian artery.

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  Fig. 2 Photograph of the right common carotid artery-left common carotid artery cross over bypass graft.

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  Fig. 3 Computed tomography scan performed 4 weeks after the endovascular procedure, showing successful exclusion of the aortic aneurysm without evidence of any leakage.

Reference

1. Schoder M, Grabenwöger M, Hölzenbein T, Cejna M, Ehrlich MP, Rand T, Stadler A, Czerny M, Domenig CM, Loewe C, Lammer J. Endovascular repair of the thoracic aorta necessitating anchoring of the stent graft across the arch vessels. J Thorac Cardiovasc Surg. 2006. 131:380–387.

2. Pennell RC, Hollier LH, Lie JT, Bernatz PE, Joyce JW, Pairolero PC, Cherry KJ, Hallett JW. Inflammatory abdominal aortic aneurysm: a thirty-year review. J Vasc Surg. 1985. 2:859–869.

3. Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med. 1994. 331:1729–1734.

4. Walsh SR, Tang TY, Sadat U, Naik J, Gaunt ME, Boyle JR, Hayes PD, Varty K. Endovascular stenting versus open surgery for thoracic aortic disease: systematic review and meta-analysis of perioperative results. J Vasc Surg. 2008. 47:1094–1098.

5. Vasseur MA, Haulon S, Beregi JP, Le Tourneau T, Prat A, Warembourgh H. Endovascular treatment of abdominal aneurysmal aortitis in Behçet's disease. J Vasc Surg. 1998. 27:974–976.

6. Swartbol P, Truedsson L, Norgren L. The inflammatory response and it's consequence for the clinical outcome following aortic aneurysm repair. Eur J Vasc Endovasc Surg. 2001. 21:393–400.

7. Puchner S, Bucek RA, Rand T, Schoder M, Hölzenbein T, Kretschmer G, Reiter M, Lammer J. Endovascular therapy of inflammatory aortic aneurysms: a meta-analysis. J Endovasc Ther. 2005. 12:560–567.

8. Puchner S, Bucek RA, Loewe C, Hoelzenbein T, Kretschmer G, Reiter M, Lammer J. Endovascular repair of inflammatory aortic aneurysms: long-term results. AJR Am J Roentgenol. 2006. 186:1144–1147.

9. Ryu YG, Choo SJ, Lim JY, Yoon HK, Chung CH. Hybrid procedure for a traumatic aortic rupture consisting of endovascular repair and minimally invasive arch vessel transposition without sternotomy. J Korean Med Sci. 2010. 25:142–144.

10. Mitchell RS, Ishimaru S, Ehrlich MP, Iwase T, Lauterjung L, Shimono T, Fattori R, Yutani C. First international summit on thoracic aortic endografting: roundtable on thoracic aortic dissection as an indication for endografting. J Endovasc Ther. 2002. 9:Suppl 2. II98–II105.

11. Ozsvath KJ, Roddy SP, Darling RC 3rd, Byrne J, Kreienberg PB, Choi D, Paty PS, Chang BB, Mehta M, Shah DM. Carotid-carotid crossover bypass: is it a durable procedure? J Vasc Surg. 2003. 37:582–585.

12. Abou-Zamzam AM Jr, Moneta GL, Edwards JM, Yeager RA, McConnell DB, Taylor LM Jr, Porter JM. Extrathoracic arterial grafts performed for carotid artery occlusive disease not amenable to endarterectomy. Arch Surg. 1999. 134:952–957.

13. Manart FD, Kempczinski RF. The carotid-carotid bypass graft. Arch Surg. 1980. 115:669–671.

14. Liu CW, Ye W, Liu B, Wu W, Dake MD. Endovascular treatment of aortic pseudoaneurysm in Behçet disease. J Vasc Surg. 2009. 50:1025–1030.