1Akhil Monga, 1Mathew Cherian, 1Pankaj Mehta, 1Santhosh P

1Kovai Medical Center and Hospitals, Coimbatore, India

Case Report:

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 peri-procedural complications. Patient presented two months later with a non-tender 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 post procedure CT, one of the sternal sutures were 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 six months follow up with no endoleak or recurrence of mediastinal collection