Emory Heart & Vascular

Aneurysms in the aortic arch are uncommon, accounting for about 10% of thoracic aorta aneurysms. Very rarely, an aneurysm affects the entire aortic arch.

Typically, patients must undergo open heart surgery to treat aneurysms involving the ascending aorta and the aortic arch—an operation that can be especially risky in older people or those with comorbid conditions.

Recently, an older patient with an aneurysm involving the distal ascending aorta and arch was referred to aortic specialists at Emory Heart & Vascular. He was deemed high risk for traditional open surgical repair, and therefore was enrolled in the ARISE II trial, a multi-center national clinical trial evaluating the Gore® Ascending Stent Graft in the treatment of aneurysms involving the ascending aorta. The trial is evaluating a novel stent-graft designed specifically for the ascending aorta. In this patient, the novel ascending stent graft was combined with a commercially available branched arch stent graft to achieve a seal from the ascending aorta, across the aortic arch and into the descending aorta to successfully treat this complex aneurysm.

The procedure was performed with excellent results by vascular surgeon Yazan Duwayri, MD, Chief of Vascular Surgery and Endovascular Therapy at Emory Healthcare, and cardiothoracic surgeon Bradley Leshnower, MD, Director of Thoracic Aortic Surgery at Emory Healthcare.

The patient, an 81-year-old man, had been diagnosed with an aneurysm in his aortic arch. Due to his age and comorbidities, repairing the aneurysm via an open surgery was deemed high risk. The patient was referred to aortic specialists at Emory Heart & Vascular, where he underwent a minimally invasive hybrid arch repair.

The procedure was completed in two stages. First, Yazan Duwayri, MD, rerouted the arteries going to the brain and arm with a bypass graft to the brachiocephalic artery. After an in-hospital recovery period of four days, the patient underwent the second operation, performed by Drs. Duwayri and Leshnower.

The surgeons performed the procedure via percutaneous access in the right arm, and the right and left femoral arteries. After placing a stent graft across the aortic arch with a branch into the brachiocephalic artery, the novel stent graft was placed into the ascending aorta. A completion aortogram demonstrated complete exclusion of blood flow into the aneurysm. The patient’s breathing tube was removed in the operating room, where he regained consciousness. Five days later, he was discharged home and resumed normal activities.