EURORAD ESR

Case 9705

Unusual lesion of the left subclavian artery and unusual endovascular repair

Author(s)
Fabio Pozzi Mucelli, Sandro Pulvirenti, William Toscano, Stefano Cernic, Maria Cova

Struttura Complessa di Radiologia,
Az. Ospedaliero-Universitaria
Ospedali Riuniti di Trieste, Italy;
Email:pozzi-mucelli@libero.it
 
Patient
male, 70 year(s)
 
 
  • Figure 1
    Preoperative imaging
     

    (A-P projection, supine): paramediastinic ill defined mass of the left upper pole.

     
    Area of Interest: Thorax; Imaging Technique: Conventional radiography; Procedure: Diagnostic procedure; Special Focus: Aneurysms;

    Coronal plane: large aneurysm arising from the arch.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Aneurysms;

    Diagnostic angiography shows the large aneurysm arising from the origin of the left subclavian artery in a patient with a bovine arch.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: Catheter arteriography; Procedure: Diagnostic procedure; Special Focus: Aneurysms;
     
     
  • Figure 2
    Endovascular treatment
     

    After catheterization of the aneurysmatic sac the large self-expandable stent was deployed in the arch in order to avoid coils protrusion from the sac.

     
    Area of Interest: Cardiovascular system; Imaging Technique: Catheter arteriography; Procedure: Embolisation; Special Focus: Aneurysms;

    A "sizing balloon" was used to correctly expand the self-expandable stent.

     
    Area of Interest: Cardiovascular system; Imaging Technique: Catheter arteriography; Procedure: Stents; Special Focus: Aneurysms;

    Check angiography after coiling of the sac (200 cm of coils).

     
    Area of Interest: Cardiovascular system; Imaging Technique: Catheter arteriography; Procedure: Embolisation; Special Focus: Aneurysms;

    Check angiogram: good filling of the sac. Regular flow through the stent.

     
    Area of Interest: Cardiovascular system; Imaging Technique: Catheter arteriography; Procedure: Embolisation; Special Focus: Aneurysms;
     
     
  • Figure 3
    CT follow-up
     

    Volume rendering elaboration shows the coils which have completely filled the aneurysmatic sac and the stent in the correct position.

     
    Area of Interest: Cardiovascular system; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Aneurysms;

    MPR elaboration shows good filling of the sac with the coils; the stent shows a poor flexibility with a central kinking; however, the flow is good.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Embolisation; Special Focus: Aneurysms;
     
     
(A-P projection, supine): paramediastinic ill defined mass of the left upper pole.
 
Coronal plane: large aneurysm arising from the arch.
 
Diagnostic angiography shows the large aneurysm arising from the origin of the left subclavian artery in a patient with a bovine arch.
 
After catheterization of the aneurysmatic sac the large self-expandable stent was deployed in the arch in order to avoid coils protrusion from the sac.
 
A "sizing balloon" was used to correctly expand the self-expandable stent.
 
Check angiography after coiling of the sac (200 cm of coils).
 
Check angiogram: good filling of the sac. Regular flow through the stent.
 
Volume rendering elaboration shows the coils which have completely filled the aneurysmatic sac and the stent in the correct position.
 
MPR elaboration shows good filling of the sac with the coils; the stent shows a poor flexibility with a central kinking; however, the flow is good.
 
 
 
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