Page 18 - Virtual Vascular Vol 13

CT Scan confirmed a SACCULAR aneurysm at the aortic arch, measuring 4.5 cm across.
Risk include progressive enlargement and rupture, and also L vocal cord palsy.

This can be treated by a TEVAR but the Left subclavian artery will need to be covered to
achieve good proximal landing. Concomitant Left subclavian preservation procedures
includes (1) a L Carotid-subclavian bypass, (2) A custom fenestrated graft for the LSA, (3)
In-situ fenestration procedures, and (4) A LSA “chimney” graft. If the LSA is sacrificed,
there is a small risk of posterior circulation stroke.

In view of the relatively small size of the aneurysm, the patient chose conservative treat-
ment with surveillance. The downside of this approach would be the proximal landing

zone could further deteriorate over time, and L common carotid coverage may be required.

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