Aortic arch rupture after multiple multilayer stent treatment of a thoracoabdominal aneurysm Emanuele Ferrero, MD, Lorenzo Gibello, MD, Michelangelo.

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Aortic arch rupture after multiple multilayer stent treatment of a thoracoabdominal aneurysm Emanuele Ferrero, MD, Lorenzo Gibello, MD, Michelangelo Ferri, MD, Andrea Viazzo, MD, Franco Nessi, MD Journal of Vascular Surgery Volume 60, Issue 5, Pages 1348-1352 (November 2014) DOI: 10.1016/j.jvs.2013.08.006 Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 1 The computed tomography angiography (CTA) showed the maximum increased dilatation of 81 mm at vertebral T4-T6 and a dilatation of infrarenal abdominal aortic aneurysm of 60 mm. The size of the aortic arch at the common carotid artery was 32 mm, at the subclavian artery was 30 mm, and the length between the common carotid artery and the subclavian artery was 15 mm. The distal sealing zone, at the abdominal aortic artery, had a diameter of 26.5 mm and a length of sealing zone of 40 mm. Journal of Vascular Surgery 2014 60, 1348-1352DOI: (10.1016/j.jvs.2013.08.006) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 2 A, Fluoroscopic images of Cardiatis multilayer flow modulator (CMFM) deployment. B, Modules and the ballooning maneuver showed CMFMs shortening with loss of both central overlapping regions. C-D, A fourth CMFM was positioned and ballooned. Presence of an image of infolding in the proximal end point. E-H, After the proximal end point ballooning, the CMFM retracted and dislocated, so a fifth CMFM was deployed, covering the whole aortic arch and landing in the ascending aorta. I-K, Fluoroscopic images of final control after CMFMs' deployment. Journal of Vascular Surgery 2014 60, 1348-1352DOI: (10.1016/j.jvs.2013.08.006) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 3 The autopsy images revealed the rupture of the aortic arch in proximity of the descending tract. Journal of Vascular Surgery 2014 60, 1348-1352DOI: (10.1016/j.jvs.2013.08.006) Copyright © 2014 Society for Vascular Surgery Terms and Conditions