Endovascular treatment of perforating aortic ulcerations coexisting with thoracoabdominal aneurysm: case report and literature review

The aim of the study was to introduce endovascular repair of excessive PAUs and thoracoabdominal aneurysm by staged Zenith alpha and T-branch application in a patient with PAU, thoracoabdominal aneurysm and subclavian steal syndrome, additionally managed by carotid-subclavian bypass. We present a case of a 71-year-old woman with four excessive life-threatening thoracic penetrating aortic ulcers (PAUs, maximum diameter 57 mm), accompanied with thoraco-abdominal aortic aneurysm (TAAA) - Crawford IV (max diameter 65 mm) and severe asymptomatic left subclavian artery (LSA) stenosis due to its compression by proximal PAU. In response to this serious life-threatening condition, we performed staged endovascular repair, starting with thoracic stent-graft implantation with coverage of LSA ostium, using thoracic stent-graft (The Cook Zenith Alpha). The patient unexpectedly presented postoperative symptomatic subclavian steal syndrome and left-hand ischaemia. On the fourth postoperative day, a carotid-subclavian bypass was performed, and the patient was discharged in a good general condition. Three months later the patient underwent endovascular thoraco-abdominal aneurysm repair using a multibranched off-the-shelf stent-graft (Zenith T-branch), a week later angio-CT was performed to confirm treatment efficacy, and the patient was discharged in a good general condition. Endovascular treatment of PAUs coexisting with TAAA is possible and feasible even with total aorta exclusion.