An 80-year-old male with a history of coronary artery disease and bypass grafting presented with shortness of breath. Imaging revealed a saccular aneurysm originating from the thoracic aorta. The patient underwent an endovascular stent graft placement across the left subclavian artery. During the procedure, a fenestration was made in the stent graft and an 8mm covered stent was inserted through the fenestration and into the left subclavian artery to preserve blood flow to that vessel. The patient was discharged after 4 days and was asymptomatic at his 2-week follow-up, with plans for continued monitoring.

1. On table fenestration stent
graft to saccular aneurysm
of thoracic aorta.
 80 yrs male
 CAD-TVD (1996)
 CABG (1996) X 3 Grafts, LIMA – LAD, SVG -
RAMUS and PLVB.
 HTN (10 yrs), Hypothyroidism (1 yr).
 SR, No CHF, Good LV Function.

2.  Acute SOB – 3 months back.
 X-ray chest- showed saccular aneurysm.
 On evaluation found saccular aneurysm
measuring 3.8 x 4.1 cm arising from
arch/isthmus of aorta after origin of left
subclavian artery projecting anteriorly and
laterally showing mural thrombus and
burrowing into lung parenchyma.

3.  Stent graft 36 x 77mm endovascular graft was
done on 1/9/12 across left subclavian artery.
 On table fenestration of stent graft was done.
 Left subclavian stent through fenestration 8 x
38 mm covered stent inserted through left
brachial artery.

12.  Plan to protect left sub clavian artery- LIMA
to LAD.
 2 options- hybrid procedure
 Custom made fenestration
 On table fenestration

38.  Discharged home on day4
 15 days follow up
 Asymptomatic
 Will do follow up CT angio- 6 months.