Out of many strategies that are used to treat aortic arch disease, including open surgery, branched techniques, and hybrid repair with Thoracic Endovascular Aortic Aneurysmal Repair (TEVAR) and supra-aortic branch reconstruction and fenestration, Thoracic Endovascular Aortic Aneurysmal Repair (TEVAR) incorporating chimney is frequently used in unstable and morbid patients not suitable for other procedures. We describe here a case of contained rupture of a thoracic aortic aneurysm, which was treated with TEVAR incorporating a double chimney to the left common carotid and left subclavian arteries. There was an uncomplicated course of the procedure with complete coverage of aneurysm with stent-graft and open aortic arch vessels when followed up to 6 months. There were no complications noted as well. In this case we took the precaution to upsize the stent-graft by 20% to 30% also for adequate coverage of aneurysm we had to adopt to the chimney technique. To prevent complications like gutter and endoleaks, the kissing technique was used during deployment. In addition, there was adequate coverage of chimney-grafts with adequate proximal projection.
Hybrid repair of a very late, post-aortic coarctation surgery thoracic aneurysm: a case report
