We report a case of a 68-year-old male, chronic smoker and hypertensive, with incidentally
detected fusiform aneurysm involving the descending thoracic aorta just distal to
the left subclavian artery origin. Patient underwent hybrid TEVAR procedure with total
arch debranching followed by endovascular placement of two overlapping stent grafts
without any periprocedural complications. Patient presented 2 months later with a
nontender midline anterior chest wall swelling. CT aortogram revealed a collection
in the anterior mediastinum in contact with anterior aspect of the left subclavian
surgical bypass graft with opacification in the arterial phase. On retrospective analysis
of the immediate postprocedure CT, one of the sternal sutures was seen in close contact
with the anterior aspect of the left subclavian graft. Hence a provisional diagnosis
of a focal full-thickness defect of the surgical graft with an adjacent contained
hematoma secondary to abrasive injury caused by the adjacent sternal suture was made.
It was treated by endovascular repair of the eroded surgical graft using a stent graft
which was deployed through a left brachial artery surgical cut down access. The sternal
sutures adjacent to the stent graft were surgically removed. Patient was stable at
6-month follow-up with no endoleak or recurrence of mediastinal collection.
