Case Study: Male, 82 years old.
Present Illness: Enhanced CT scan revealed an infrarenal abdominal aortic aneurysm(60mm) and an aortic arch aneurysm(45mm). We placed a stent graft on the abdominal aortic aneurysm using a Gore Excluder^®. The post-operative period passed without incident and led to outpatient observation. A follow-up CT scan revealed expansion(50mm) of the aortic arch aneurysm and the decision was made to operate.
Operation: First we performed a right axillary-left common carotid artery-left subclavian artery bypass operation using Ringed Gelsoft 8mm. We placed a Talent^® thoracic stent graft just distal of the brachiocephalic trunk. Just subsequent to balloon fixation, INVOS^® values fell. It was determined that the stent graft had covered the inlet of the brachiocephalic trunk, resulting in stenosis. We immediately inserted a balloon catheter through the right radial artery, avoiding the stent graft at the inlet of the brachiocephalic trunk, and placed a stent at the inlet of the brachiocephalic trunk. INVOS values improved.
Results: Whole brain ischemia occurred for about 5 minutes. Postoperative recovery from anesthesia was delayed and there was right hemiplegia. This gradually improved and the patient was able to walk unassisted at time of discharge.
Summary: INVOS^® was an effective cerebral blood flow monitor during TEVAR in the aortic arch.