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Endovascular thoracic aortic aneurysm repair with concomitant myocardial and carotid revascularization

Keshava Rajagopal1, Brian Lima, J Kevin Harrison

  • 1Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA.

The Annals of Thoracic Surgery
|June 26, 2007
PubMed

Insights

This study details a complex case of a 73-year-old woman with a distal aortic arch aneurysm and significant coronary and carotid artery stenoses. A multi-procedural approach successfully addressed these critical vascular issues.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • A 73-year-old female patient presented with a large saccular aneurysm of the distal aortic arch.
  • Preoperative diagnostics revealed concurrent left main coronary artery and left common carotid artery stenoses.

Observation:

  • The patient required simultaneous management of aortic pathology and significant atherosclerotic disease in major arteries.
  • This complex presentation necessitated a multi-faceted surgical and endovascular strategy.

Findings:

  • A successful hybrid procedure was performed, including coronary artery bypass grafting (CABG) and ascending aorta-to-left common carotid artery bypass.
  • Endovascular thoracic aortic aneurysm repair (ETAR) was completed with antegrade stent-graft deployment, intentionally covering the left subclavian artery.

Implications:

  • This case highlights the feasibility of combined surgical and endovascular techniques for complex aortic arch and coronary/carotid disease.
  • Such hybrid approaches can offer a viable solution for high-risk patients with multiple vascular comorbidities.

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