Endovascular Treatment of a Giant Aortic Arch Aneurysm With a Triple-Branched Stent Graft
An 86-year-old woman was referred for treatment of a rapidly enlarging aortic arch aneurysm, which had been monitored for 2 years with serial computed tomography (CT) scans. The size of the aneurysm had been 65 mm 2 years previously, but it had enlarged to 110 mm at the most recent examination (Figure 1). The patient complained of hemosputum and back pain. The risk of rupture was considered very high if the aneurysm was left untreated; however, thoracotomy was considered high risk because of the patient’s age. After obtaining the informed consent of the patient, which was approved by the institutional review board, we performed endovascular repair using a triple-branched Inoue stent graft under general anesthesia. The stent graft was custom-made for the patient (Figure 2). The stent graft consisted of an aortic section and 3 branched sections. The stent graft was introduced thorough a 24F sheath inserted in the right iliac artery (Figure 3). The procedure time was 8 hours, and we used 573 mL of contrast media. The procedure was completed without any complications. The postoperative CT scan demonstrated complete sealing of the aneurysm. Patency of the branched sections was confirmed by 3D reconstruction of the CT scan and virtual angioscopy (Figure 4). The CT scan with 3D reconstruction and virtual angioscopy was very useful to confirm patency of the branched section of the graft. The patient required prolonged hospitalization because of atrophy of the lower limbs caused by disuse. Except for disuse atrophy, the patient developed no other complications.
Dr Inoue developed and manufactures the Inoue stent-graft and is named as an inventor on patents relating to the Inoue stent-graft.