TEVAR for TTAI has superior survival outcomes and has replaced OR. SRC requiring reintervention is associated with malapposition and the use of TSG. Until TTAI-specific endografts become available, use of AEC may minimize malapposition and reduce reinterventions. Routine overstenting of the LSA is not necessary and may increase SRC.

Objective(s):This study reviewed a single-institution contemporary experience with extracranial aneurysms of the carotid artery.Methods: Patients evaluated for an aneurysm of the extracranial carotid artery from 2005 to 2010 were reviewed. Mean follow-up was 21 months (range, 1-58 months).Results: During the study period, 18 aneurysms were identified in 17 patients. Of these, 14 (6 men and 8 women; mean age, 62 years) underwent surgical repair (77.8%). One pseudoaneurysm resolved on follow-up imaging, and three were small for repair. The mean aneurysm size was 2.5 cm in greatest length. One patient presented with neurologic symptoms (7.1%), and 13 were asymptomatic. The underlying etiology was trauma in five (35.7%), prior carotid endarterectomy in five (35.7%), and atherosclerosis in four (28.6%). Aneurysms were isolated to the common carotid artery in six (42.9%), internal carotid artery in five (35.7%), and the carotid bifurcation in three (21.4%). Five patients underwent aneurysmectomy with primary repair, nine underwent repair with an interposition graft, and one patient had a plication and patch angioplasty. No deaths or neurologic events were documented within 30 days. One patient required reintervention at 4 months for stenosis of the bypass graft, and one patient died at 10 months from an unrelated condition.Conclusions: Carotid artery aneurysms are uncommon and usually asymptomatic. Prior trauma or carotid surgery were common etiologies. The location of the aneurysms was equally distributed between the internal and common carotid arteries. Surgical repair was safe and effective, with no significant morbidity or mortality and good midterm stroke prevention.

Objectives: One of the major limitations to endovascular treatment of the thoracic aorta is inadequate landing zone (LZ), thrombus or heavy calcification within the LZ. Debranching of the aortic arch vessels has been used as a solution with good results. Stenting of the supra-aortic branches, the "snorkel" technique, has been described with immediate good results but the short to intermediate term outcomes are not well described.Methods: Between January 2008 and December 2009, 16 TEVARs were performed using the "snorkel" technique for the supra-aortic branches. The indication for using this technique was inadequate LZ, and thrombus within the LZ. The charts were retrospectively reviewed and the patients were followed in the aortic disease clinic.Results: The mean age of the patients was 62 years (range 46-84). There were 6 (38%) females and 10 (62%) males. The pathologies included aneurysms, chronic type B dissections, and traumatic aortic transections. One (6.3%) snorkel was placed in the innominate artery, 4 (25%) in the left common carotid artery (CCA), and 11 (69%) in the left subclavian artery (SCA). The mean follow-up period is 14 months (range 3-28 months). There was one (6%) death unrelated to the procedure. There were no instances of stroke or paralysis. There were no stent fractures. One (6.3%) stent became occluded a week after implantation and needed to be revised. There was one case of persistent type Ia endoleak.Conclusions: Placement of endoluminal grafts beyond zone 2 is a more challenging and complicated procedure. These cases require meticulous planning and careful management of the supra-aortic branches. Our short-term results support the use of this technique in appropriately selected cases, to extend the LZ beyond zone 2. Long term results are pending.