Preemptive Aneurysm Sac Embolization for Thoracic Endovascular Aortic Repair With Inadequate Proximal Landing Zone Jacky Y.K. Ho, MRCS, Randolph H.L.

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Preemptive Aneurysm Sac Embolization for Thoracic Endovascular Aortic Repair With Inadequate Proximal Landing Zone Jacky Y.K. Ho, MRCS, Randolph H.L. Wong, FRCS, Simon C.Y. Chow, MRCS, Peter S.Y. Yu, MRCS, Micky W.T. Kwok, FRCS, Malcolm J. Underwood, FRCS, Simon C.H. Yu, MD, FRCR The Annals of Thoracic Surgery Volume 102, Issue 6, Pages e489-e491 (December 2016) DOI: 10.1016/j.athoracsur.2015.12.038 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (a) Axial view of computed tomography of the thoracic aneurysm showed the preoperative aneurysm. (b) Postoperatively, the proximal end of the endovascular stent (arrow), embolization coils, and thrombosed aneurysmal sac (dotted arrow) are observed, with no significant endoleak. The Annals of Thoracic Surgery 2016 102, e489-e491DOI: (10.1016/j.athoracsur.2015.12.038) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (a) Intraoperative digital subtraction angiogram highlights inadequate landing zones of the outer (A = 2.2 cm) and inner (B = 1.7 cm) aortic arch; the Renegade HI-FLO catheter was positioned within the aneurysmal sac and aligned according to the triangles. (b) Postprocedure angiography shows the Penumbra Ruby coils within the aneurysmal sac (arrow), embolization of the left subclavian artery (white square), and exclusion of the left common carotid artery by the stent (white dot). The Annals of Thoracic Surgery 2016 102, e489-e491DOI: (10.1016/j.athoracsur.2015.12.038) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Three-dimensional computed tomography aortic arch reconstruction of the (a, c) posterior-anterior view and (b, d) left anterior oblique 45-degree view. (a, b) Preoperative reconstruction demonstrated the inadequate landing zone. (c, d) The postoperative status of the stent system, showing the Penumbra Ruby coils (dotted arrow), and that debranching of the head and neck vessels was patent (arrow). The Annals of Thoracic Surgery 2016 102, e489-e491DOI: (10.1016/j.athoracsur.2015.12.038) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions