New Technique for Expanding the Proximal Landing Zone in Thoracic Endovascular Aneurysm Repair: Case Report

A thoracic aortic aneurysm is a dilatation in the wall of the aorta. If untreated, it can rupture or tear, which is life-threatening. A 74-year-old man was admitted to Sina Hospital with hoarseness and dysphonia. He was diagnosed with a thoracic aortic aneurysm (TAA) measuring 73 mm near the left subclavian artery and a 46 mm saccular ulcerous TAA in the mid-thoracic aorta. Preoperative evaluations were normal. Due to comorbidities, open surgery was not an option, so the patient was selected for thoracic endovascular aneurysm repair (TEVAR). However, the proximity of the aneurysm to the origins of the left subclavian and common carotid arteries limited the stent's landing zone. To resolve this, an open surgery was performed to ligate the left subclavian and common carotid arteries and bypass them to their right counterparts, extending the landing zone for the stent. TEVAR was then successfully carried out from the brachiocephalic trunk, covering most of the ulcerous TAA in the mid-aorta. The patient was discharged in good condition and has shown positive progress in follow-up visits. This case demonstrates a novel and complex approach that combines open surgical ligation and bypass of the left subclavian and common carotid arteries with TEVAR. The technique successfully expands the proximal landing zone for thoracic aortic aneurysm repair, contributing a practical solution for high-risk patients with complex anatomy, leading to effective stent deployment and enhanced clinical outcomes.