Endovascular aortic arch reconstruction using in situ stent-graft fenestration in the brachiocephalic artery.

A patient who had previously undergone retrosternal gastric tube reconstruction for esophageal cancer presented with an aortic arch aneurysm. The patient was treated with endovascular stent-graft placement without median sternotomy, followed by revascularization of the brachiocephalic trunk using percutaneous in situ graft fenestration. A 9-month follow-up examination revealed marked regression of the aneurysm with patency of the stent-graft, without any complications. This in situ fenestration technique may extend the limits of thoracic endovascular therapy for patients who are unsuitable for sternotomy or aortic side-clamping.