Yonsei Med J.  2013 Jan;54(1):258-261. 10.3349/ymj.2013.54.1.258.

Thoracic Endovascular Aortic Repair with the Chimney Technique for Blunt Traumatic Pseudoaneurysm of the Aortic Arch in a No-Option Patient

• Kim WH
• Choi JH
• Park SH
• Choi YJ
• Jeong KT
• Park SC
• Lee S

• KMID: 1776948
• DOI: http://doi.org/10.3349/ymj.2013.54.1.258

Abstract

A 42-year-old man was involved in a motor vehicle collision. Imaging studies revealed the presence of a post-traumatic aortic pseudo-aneurysm (about 34x26 cm) arising from the descending thoracic aorta at the level of the left subclavian artery (LSA), prone to rupture. Thoracic endovascular aneurysm repair (TEVAR) was the only feasible option due to his poor overall medical status. In this case, LSA needed to be covered in order to extend the proximal landing zone. Eventually, modified TEVAR was successfully performed by means of the chimney technique to preserve flow to the LSA and to prevent flow into the pseudoaneurysmal sac.

Keyword

Thoracic endovascular aneurysm repair; chimney technique

MeSH Terms

Accidents, Traffic
Adult
Aneurysm, False
Aorta, Thoracic/radiography/*surgery
Aortic Aneurysm, Thoracic/radiography/*surgery
Cerebral Hemorrhage/radiography/surgery
Endovascular Procedures/*methods
Humans
Male
Subclavian Artery/radiography/surgery
Tomography, X-Ray Computed
Treatment Outcome
Wounds, Nonpenetrating/radiography/surgery

Figure

• 

  Fig. 1 Pseudoaneurysm and its relationship with surrounding structures. (A) Saccular pseudoaneurysm was noted just distal to the orifice of the LSA on the lesser curvature of the aorta on the three-dimensional reconstruction image of the CT. (B) Axial CT scan showed the presence of a post-traumatic aortic pseudo-aneurysm (about 34×26 cm) arising from the DTA at the level of the LSA. LSA, left subclavian artery; CT, computed tomography; DTA, descending thoracic aorta.

• 

  Fig. 2 Endograft deployment resulted in near-total coverage of the LSA (A), followed by retrograde chimney stenting of the LSA origin via the trans-brachial approach (B). The landmark for stent graft placement was the origin of the left CCA. Note that the chimney stent was delivered in advance into the LSA, with protruding into the aortic arch lumen. LSA, left subclavian artery; CCA, common carotid artery.

• 

  Fig. 3 7 days follow-up CT showing good device morphology and no leakage, patent left CCA, LSA (A), and complete exclusion of the thoracic aortic pseudoaneurysm (B). CT, computed tomography; CCA, common carotid artery; LSA, left subclavian artery.

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