Contained rupture of an aortic arch aneurysm in a patient with syphilitic aortitis. A case report

Figures

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  Figure 1. Preoperative computed tomography angiography (CTA) showing rapid growth of the syphilitic aortic arch aneurysm 55 days after the first visit to the outpatient’s clinic (A, B, C) and the urgent setting. (D, E, F) Sagittal (A/D), axial (B/E), and coronal (C/F) views of the two preoperative CTAs, almost two months apart.

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  Figure 2. Preoperative CTA of the syphilitic aortic arch aneurysm characterized by focal and crescentic intramural hematomas (white *) - small regions of contrast accumulation with invisible or small communication with the true lumen, often with a peripheral connection with an intercostal or lumbar artery -, areas of eccentrically thickened aortic wall (white +), and ulcer-like projections with a wide neck (black arrows).

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  Figure 3. Intraoperative images. (A) exposure of the ascending aorta and the supra-aortic vessels (in this case: brachiocephalic trunk and left common carotid artery) through median sternotomy; (B) ascending aorta to the brachiocephalic trunk and left common carotid artery bypasses. Anastomoses to both vessels are highlighted. Note the ligature of the third branch of the trifurcated graft.

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  Figure 4. Endovascular component of the hybrid aortic arch repair. (A) pre-operative angiography showing patency of the supra-aortic vessels debranching’s and aneurysm perfusion; (B) after thoracic endovascular stent-graft repair, complete aneurysm exclusion was observed.

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  Figure 5. 6-month follow-up computed tomography angiography 3D reconstruction showing complete exclusion of the aneurysm without any signs of endoleak, patency of the supra-aortic vessels, and no further aneurysm formation in the remnant aorta. (A) Sagittal view; (B) axial view; (C) coronal view.