Page 26 - Virtual Vascular Vol 19

Arch Aneurysm

A 81-year old patient experienced intermittent severe chest pain with progressive hoarseness.
CXR showed a mediastinal shadow and CT scan confirmed a large saccular aneurysm in the aortic
arch. The entire thoracic aorta was also diseased with mural thrombus.

This appearance is highly suggestive of a symptomatic aneurysm with growth and impending
rupture. With modern advances in Vascular Surgery this can now be readily treatable with an
endovascular stent graft in the arch with side branches to preserve the arch vessels, instead of the

open total arch replacement under cardiopulmonary bypass. Endovascular treatment still carries
a risk mainly of stroke due to the shaggy aorta, but is much safer than open repair. Durability may
not be an issue in an elderly man with multiple co-morbidities.

However, as typical of patients in this locality, the patient had heeded to ill advice and considered
intervention to be risky. He declined all forms of treatment and accepted the risk of eventual rup-
ture and death.

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