Embolization of VBJ fenestration aneurysm

Authors: KASS-HOUT Omar, BECSKE Tibor

Discover the case of a 67-year-old construction worker with right arm claudication and an incidental 13 mm bi-lobed aneurysm associated with VBJ fenestration. The medical team opted for a CCA/Axillary bypass to relieve symptoms and preserve subclavian flow.

• Case presentation

  Patient presentation

  • 67-year-old male construction worker with Rt arm claudication
  • CTA neck: Rt Proximal Subclavian artery occlusion

   

  

   

  • Incidentally, VBJ fenestration Bi-Lobed aneurysm ~ 13 mm

   

  

   

  

   

  Treatment decision

  • CCA/ Axillary bypass: Symptomatic relief, ability to sacrifice Rt vertebral without jeopardizing Rt SC flow
  • Flow diversion at the inferior aspect of the fenestration on the left
  • Avoid coverage, if possible, of the AICAs (No Rt PICA and dominant left AICA) and ASA.
  • Sacrificing the right vertebral along with the aneurysm and Rt arm of fenestration

   

   

  Treatment plan

   

  
• Intervention

  Intervention

  Embolization

  • Access:
    • Left vert(femoral A.):
      • Ballast
      • 6 Fr Sofia
      • Headway 27
      • Fred X 4X13
    • Rt vert( radial A.):
      • 6 Fr Benchmark
      • Excelsior l 10
      • HYDROFRAME Coils
  • Alternatives in US:
    • Pipeline
    • Surpass Evolve

   

  

   

  • The right arm of fenestration became more obvious after partial deployment of stent due to straightening of VBJ
  • Given wide neck and to avoid thromboembolic events, decision was to continue to occlude the right vert with aneurysm and fenestration.

   

  

   

  Stent deployment

   

  

  
• Final