Eight-year follow-up of endovascular repair of a brachiocephalic trunk aneurysm due to Takayasu's arteritis

Abstract

Aneurysms of the brachiocephalic trunk are rare but their clinical outcomes are potentially devastating; they include rupture, cerebral or arm ischemia secondary to thromboembolism, and compression of the surrounding structures. Although open repair has proven successful, it is associated with significant morbidity and mortality rates. Endovascular treatment, if anatomically feasible, may offer a safer and less invasive approach to these lesions, especially in high-surgical-risk patients. We report the good long-term outcome of endovascular repair of a large innominate artery true aneurysm due to Takayasu's arteritis. A stent graft was safely and successfully deployed to exclude the aneurysm; assessment by vascular imaging at 8-year follow-up demonstrated the efficacy of the procedure.

Surgical treatment of innominate artery and aortic aneurysm: a case report and review of the literature

“…However despite these potential benefits, careful patient selection is needed and long-term outcome data remains lacking. Endovascular treatments can also be challenging in cases of bovine arch morphology [16], where the aneurysmal neck is inadequate for attachment of the graft or when the distal innominate artery is involved [7,11]. Furthermore, covered endovascular stents may require long-term antiplatelet therapy and a closed approach presents diagnostic difficulty in ruling out any malignant processes underlying aneurysm formation [18].…”

Endovascular Treatment of Multiple Aneurysms Complicating Cogan Syndrome

“…Moreover, in arteritis, aneurysms of the supra-aortic trunks, covered stents seem to yield a favorable outcome also in the long term. 5,9 In conclusion, endovascular repair seems to have favorable long-term outcomes in patients with suitable anatomy and should be considered a viable alternative to surgery in unfit for open surgery patients, even if they are young, and when the aneurysm size and location would pose a higher risk of perioperative and postoperative complications after an open surgical procedure.…”

“…Moreover, the aneurysms' morphology was suitable for endovascular repair even if the patient had arteritis. 4,5 Repair of descending thoracic aneurysms has already proven an important new therapeutic option for patient management, and is becoming an increasingly common procedure in clinical practice. 6 A Medicare population study published in 2010 7 found that 30-day mortality for thoracic endovascular aortic repair (TEVAR) of nonruptured aneurysms was 5.2%, comparing favorably to the 12% mortality associated with open repair.…”

A complicated case of innominate and right common arterial aneurysms due to Takayasu’s arteritis

“…The complications of IAA include rupture, embolization, and compression of adjacent structures. Surgery may be recommended in IAA patients to prevent the complications[2]. Endovascular therapy has been an alternative to open surgery in some IAA cases[2,3], but open repair is still necessary in complicated cases.…”