Thoracic endovascular stent graft with a bird's beak sign

摘要

A 21 yr-old male patient, with closed chest injury, presented for endovascular repair of a traumatic descending thoracic aortic pseudo-aneurysm. The preoperative computed tomography scan demonstrated the presence of a pseudo-aneurysm just distal to the left subclavian artery. It was also noted that the junction between the aortic arch and descending aorta was abnormally at a sharp right angle. Following induction of anesthesia, a transesophageal echocardiography (TEE) probe was inserted. The aortic pseudo-aneurysm was identified and the TEE deployment zone measurements were obtained. A Zenith (Cook, Inc., Bloomington, IN, USA) thoracic endovascular graft was deployed at the aortic arch proximal to the left subclavian artery, but distal to the left common carotid artery. Upper esophageal TEE views of the aortic arch demonstrated a type I1 endoleak with a right angle present between the graft and the aortic wall, leading to a bird's beak sign formation2 (Figures 1, 2 and 3).