We present a hybrid approach to the management of an aortic aneurysm in a right-sided aortic arch with aberrant left subclavian artery and associated Kommerell's diverticulum. The aneurysm extended from the origin of the left common carotid artery to the mid-descending thoracic aorta. A bilateral carotid to subclavian artery bypass was performed followed by endovascular placement of a customized fenestrated thoracic endovascular aortic repair device (TEVAR, Cook Medical, Australia). Endovascular stents (Viabahn, Gore Medical, Arizona) were placed in the carotid arteries bilaterally and Amplatzer II plugs (AGA Medical Corporation) were used to occlude the subclavian arteries. Follow-up imaging at 1 month revealed no evidence of endoleak.
Supracolic peri-pancreatic visceral pseudoaneurysms combine the challenges of difficult location for open surgical repair with unpredictable risk of fatal exsanguination. Endovascular embolisation is a well-established method of safely decompressing these lesions using a variety of thrombogenic agents. A single catheter technique is commonly employed to achieve this outcome. However, there is also a risk of iatrogenic rupture during these procedures as a result of occlusion of one vessel allowing pressure to rise through any other vessel(s). Thus a thorough understanding of the flow dynamics prior to and during occlusion is essential for safe decompression. We report the adaptation of dual arterial catheter technique in treating these lesions in an 80-year old man with a large, leaking peripancreatic visceral pseudo-aneurysm. Our technique of alternating between intervention and observation of effect allows greater control of the potentially unpredictable haemodynamic situation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.