Endovascular Repair Of Innominate Artery Aneurysms

Manish Mehta, Philip SK Paty, R. Clement Darling, III, Kathleen J Ozsvath, Benjamin B Chang, Sean P Roddy, Paul B Kreienberg, Dhiraj M Shah
Albany Medical Center, Albany, NY

The surgical treatment of innominate artery aneurysms requires a thoracotomy and is associated with a significant morbidity. We describe endovascular options for treating symptomatic true and false innominate artery aneurysms. Case 1: A 67 year old man with significant coronary artery disease, hypertension, and a history of transient hemiparesis demonstrated a large mass in the upper right hemithorax on chest radiography. A computed tomography scan (CT) confirmed the presence of a 3.3 cm innominate artery aneurysm with a 22 mm neck diameter. No other source for the right hemispheric transient ischemic attack was identified. The patient underwent successful endovascular repair using an AneuRx bifurcated stentgraft via the right common carotid artery approach. The bifurcated stentgraft was converted into an aorto-uni-limb device by placement of an aortic cuff across its flow-divider, and a carotid-subclavian prosthetic bypass done. Postoperative 1-year CT indicates the aneurysm to be excluded without stentgraft failure. Case 2: A 72 year old man presented 6 months after a motor vehicle accident with unexplained chest pain. A CT scan indicated an isolated innominate artery pseudoaneurysm measuring 2.5 cm in maximum diameter. The patient underwent a successful endovascular repair using an AneuRx stentgraft via the right common carotid artery approach. The proximal and distal landing zones were within the innominate artery, and the pseudoaneurysm was completely excluded. These cases represent the feasibility of endovascular repair of innominate aneurysms that might otherwise require a thoracotomy and open surgical repair.