Treatment of a complicated penetrating ulcer of the descending thoracic aorta using a scalloped stent graft.

We show the use of a proximal scalloped stent graft for an pseudoaneurysm of the descending thoracic aorta to avoid occlusion of the left subclavian artery. A 63-year-old man with sudden onset dysphonia was diagnosed with left vocal fold paralysis and the presence of a lung mass. A computed tomography scan revealed saccular dilatation of the aortic arch (proximal neck: <10 mm) with suggestive images of a penetrating ulcer and degenerative pseudoaneurysm. A RELAY Plus thoracic stent graft (Bolton Medical, Sunrise, FL) with proximal scallop was implanted to preserve the left subclavian artery. A custom made prosthesis with proximal scallop provides a good alternative to a carotid-subclavian bypass because it is less aggressive and can be used in nonurgent cases.