2017 Volume 26 Issue 5 Pages 285-288
The infectious brachiocephalic arterial aneurysms have high risk of rupture. The standard treatment is open surgery. It oftentimes needs thoracotomy or transsternal approach, which is invasive. Therefore, some cases of endovascular repair have been reported these years. We also had experienced a case of endovascular repair for the infectious brachiocephalic arterial aneurysm. The patient is a 65-year-old man. He received a bifurcated graft replacement for infectious abdominal aortic aneurysm using a rifampicin-bonded graft and omental wrapping. At the same time, a brachiocephalic arterial aneurysm had been complicated. We followed this aneurysm. It rapidly expanded from 21 mm into 25 mm, and the PET-CT showed a 18F-fluorodeoxyglucose integrated (maximum standardized uptake value: 8.3) into this aneurysm. We diagnosed it infectious aneurysm and performed an urgent operation. At first, the right subclavian artery was bypassed using the right common carotid artery. Then, a stent graft was implanted between the right common carotid artery and the brachiocephalic artery. After deployment, a type 2 endoleak from the right subclavian artery appeared. Coil embolization at the origin of the right subclavian artery stopped a type 2 endoleak. After the operation, an antibacterial drug was administered for several months, and his postoperative course was uneventful. Endovascular repair for infective brachiocephalic artery is an available option especially in high-risk patients, but long-term results is unknown and follow up is required.
