Hybrid treatment of a saccular aneurysm of the aortic arch - long term follow-up: A case report

Objective: We describe a complex urgent clinical case of aortic arch aneurysm treated with a hybrid intervention with a medium-long follow-up. Case presentation: A 67-years-old man presented to the emergency room for chest pain. The computed tomography angiography (CTA) documented the presence of saccular aneurysm of the aortic arch. First stage of the hybrid intervention was performed as carotid-carotid-subclavian-bypass using 7-mm PTFE graft with ringed support. The saccular aneurysm was repaired by placing a thoracic endovascular stent graft (Gore C-TAG) with Chimney technique (cTEVAR) in the anonymous trunk (with Gore Excluder Iliac Extension) to create a suitable proximal landing zone in Zone 0. Then the procedure was completed with occlusion of the left subclavian artery by plug. Final angiography and post-operative CTA document the absence of endoleaks, patency of the Chimney and bypass. At the 4th year of follow-up with Doppler ultrsound and CTA, we unexpectedly found carotid-subclavian bypass occlusion. The patient is completely asymptomatic and apparently in excellent condition at the 8-years follow-up. The Chimney is still pervious, the prosthesis is correctly placed, and the lesion has gone through complete shrinkage. Conclusion: The hybrid treatment combined with Chimney of the arch in urgent setting provides good outcomes in the medium to long term as in this case. In the present case, mid-term patient outcome was satisfactory and the patient is asymptomatic despite the closure of the bypass.