On table fenestration stent graft to saccular aneurysm of thoracic aorta. 80 yrs male CAD-TVD (1996) CABG (1996) X 3 Grafts, LIMA – LAD,

SVG -RAMUS and PLVB. HTN (10 yrs), Hypothyroidism (1 yr). SR, No CHF, Good LV Function.

Acute SOB – 3 months back. X-ray chest- showed saccular

aneurysm. On evaluation found saccular

aneurysm measuring 3.8 x 4.1 cm arising from arch/isthmus of aorta after origin of left subclavian artery projecting anteriorly and laterally showing mural thrombus and burrowing into lung parenchyma.

Stent graft 36 x 77mm endovascular graft was done on 1/9/12 across left subclavian artery.

On table fenestration of stent graft was done.

Left subclavian stent through fenestration 8 x 38 mm covered stent inserted through left brachial artery.

Plan to protect left sub clavian artery- LIMA to LAD.

2 options- hybrid procedure Custom made fenestration On table fenestration

Discharged home on day4 15 days follow up Asymptomatic Will do follow up CT angio- 6 months.