Aneurysms of thoracic aorta and abdominal aorta are rare and their treatment traditionally involved complex surgical repair with attendant morbidity and mortality. Nowadays, interventional non-surgical management with Endovascular grafting using covered stent grafts (EVAR : Endovascular Aneurysm Repair) has become the treatment of choice in the majority of cases.
This is the tale of a 67 year old hypertensive gentleman with Coronary artery Disease presenting with very large saccular Aneurysm in the Descending thoracic Aorta with another large saccular aneurysm in infra-renal abdominal aorta, again with impending rupture and layered clot in the aneurysm sac. He was refused treatment citing high risk as the reason in several placed and came to us as a last resort.
A double TEVAR and EVAR procedure was performed by Dr Y Vijayachandra Reddy, Consultant Cardiologist, Apollo Hospitals Chennai. The final result was excellent with no complications and no endo-leaks. Patient withstood the procedure well and was shifted to ICU. He has been extubated and doing well now.
The points of interest in this case are
1. Rarity of the procedure – stenting of both thoracic and abdominal aortic aneurysms in the same sitting
2. Aneurysm starting just after the left subclavian artery was considered inoperable because of high surgical risk involved and non interventionable due to lack of good landing zone for stenting. A carotid subclavian bypass was done enabling the case to be made suitable for TEVAR : the perfect example of a hybrid procedure.
3. The anatomy of abdominal aorta Aneurysm was interesting with gross disparity in size and tapering distal end precluding the use of the usual aneurysm stents . A balloon expanding Covered stent was deployed across the abdominal aorta aneurysm with post-dilation to mould the stent to the tapered aorta