Dislocation of a stent-graft into the aortic arch during endovascular repair of a descending thoracic aortic aneurysm

A 59-year-old man showed a saccular aneurysm due to a penetrating atherosclerotic ulcer, as well as a small type B aortic dissection located in the proximal descending aorta. The lesion was treated by the implantation of a stent-graft. On release, the stent-graft dislocated into the aortic arch. Intraoperative angiogram showed free perfusion of the brachiocephalic trunk and left common carotid artery; however, an overstenting of the carotid artery was apparent. Computed tomographic scan exhibited a complete covering of the supra-aortic vessels, and conventional, open aortic arch surgery was inevitable. A partial resection of the proximal part of the stent-graft was performed.