Double-barrel technique for endovascular exclusion of an aortic arch aneurysm without sternotomy

Purpose: To report the use of commercially available stents and a stent-graft in coaxial orientation to extend the proximal limits of endografting within the aortic arch. Case Report. A 70-year-old man was found to have an asymptomatic 7-cm saccular aortic arch aneurysm, extending distally from the origin of the left carotid artery and involving the left subclavian artery; there was only 11 mm between the innominate artery orifice and the aneurysm. The patient was deemed to be high risk for open surgical repair due to a history of 2 prior sternotomies and the requirement for hypothermic circulatory arrest. A "double-barrel" stent-graft strategy combining retrograde placement of an innominate stent with thoracic stent-graft implantation into zone 0 was successfully executed. The patient has continued to fare well after 10 months on close follow-up. Conclusion: The "double-barrel" stent technique may extend the limits of thoracic endografting by preserving the aortic arch branches while avoiding the need for sternotomy. Using this technique, proximal fixation can be obtained well into the ascending aorta using commercially available devices.