Aortic arch rescued through double-chimney technique

A 62-year-old man with a history of hypertension, smoking, chronic obstructive pulmonary disease and coronary artery disease had a saccular aneurysm in the distal aortic arch (Figure 1A) involving the origin of the left subclavian artery (LSA), with a maximum diameter of 65 mm and a short proximal neck distancing 13 mm from the origin of the left common carotid artery (LCCA). He was considered at high surgical risk and was referred for thoracic endovascular aortic repair with simultaneous preservation of perfusion of the innominate artery and LCCA through double-chimney technique. The procedure was performed under general anesthesia. A Gore® TAG® stent graft was first inserted through the right common femoral artery and deployed at the distal end of the aneurysm, and a second one was inserted into the ascending aorta distally overlapping with the first. Two Gore® VIABAHN® stent grafts were introduced through the right axillary artery and LCCA and deployed at the proximal edge of the proximal TAG stent graft. Post-procedure computed tomography angiography (CTA) revealed a type II endoleak from the LSA, but follow-up CTA at one month revealed no