Abstract
A 61-year old man was admitted to hospital complaining of back pain. Four years earlier, the patient had undergone an extended thymectomy combined with a left upper lobectomy and a partial aortectomy for the treatment of advanced thymic cancer. The reconstructed subclavian artery had become occluded, and a femoro-axillar bypass had been performed one year prior to the present hospital admission. A computed tomogram revealed a pseudoaneurysm of the distal aortic arch and a Stanford type B aortic dissection with a narrowed true lumen. An endovascular approach was considered to be a high-risk treatment option in this case. Furthermore, a thoracotomy or standard median sternotomy to peel off the periaortic tissue was thought to be very difficult because of the severe postoperative adhesion that was present. We decided to treat the patient by implanting an endovascular stentgraft through the proximal aortic arch under deep hypothermic circulatory arrest and selective cerebral perfusion. The stentgraft was composed of a thin-wall woven Dacron graft reinforced with a selfexpandable Z-stent and inserted into a flexible sheath with a 22 French-size diameter. The postoperative course was almost uneventful, and the patient is doing well 32 months after the operation.
