1. On table fenestration stent
graft to saccular aneurysm
of thoracic aorta.
 80 yrs male
 CAD-TVD (1996)
 CABG (1996) X 3 Grafts, LIMA – LAD, SVG -
RAMUS and PLVB.
 HTN (10 yrs), Hypothyroidism (1 yr).
 SR, No CHF, Good LV Function.

2.  Acute SOB – 3 months back.
 X-ray chest- showed saccular aneurysm.
 On evaluation found saccular aneurysm
measuring 3.8 x 4.1 cm arising from
arch/isthmus of aorta after origin of left
subclavian artery projecting anteriorly and
laterally showing mural thrombus and
burrowing into lung parenchyma.

3.  Stent graft 36 x 77mm endovascular graft was
done on 1/9/12 across left subclavian artery.
 On table fenestration of stent graft was done.
 Left subclavian stent through fenestration 8 x
38 mm covered stent inserted through left
brachial artery.

12.  Plan to protect left sub clavian artery- LIMA
to LAD.
 2 options- hybrid procedure
 Custom made fenestration
 On table fenestration

38.  Discharged home on day4
 15 days follow up
 Asymptomatic
 Will do follow up CT angio- 6 months.