endoleak after subsequent endovascular aneurysm repair. VORTEC may be particularly useful in re-do operations, where entire dissection of the visceral vessel is not necessary. This novel hybrid technique remains a single institution experience and more broad experience is necessary to establish reproducibility and safety.

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Reda Jamjoom, Nasser Alkhamees, and Cherrie Z. Abraham

A 75-year-old male has been referred to your service after a contrast–enhanced spiral computed tomography (CT) performed for investigation of chronic cough revealed an incidental finding of a 7.3 cm thoracic aortic aneurysm (TAA).

Past medical history includes moderate chronic obstructive pulmonary disease (COPD), hypertension, insulin-dependent diabetes and a history of coronary artery catheterization and stenting 5 years ago. The patient denies current angina symptoms. On examination, vital signs are stable, cardio-respiratory examination is within normal limits, and arterial examination reveals no carotid bruits, normal heart sounds without murmurs, no palpable abdominal masses and all upper and lower limb distal pulses are palpable. His routine blood work is within normal range.

Question 1

What is your next investigation?

A.  Ankle brachial index (ABI)

B.  Contrast-enhanced computed tomography angiography (CTA) of chest, abdomen and pelvis with 3D reconstruction

C.  Duplex ultrasound of the abdomen D.  Cardiac stress test

CTA was obtained (Fig. 6.1). It demonstrates a 7.3 cm saccular thoracic aortic aneurysm, beginning 3 cm distal to the subclavian artery. External iliac artery diameters are 8 mm on the right and 9 mm on the left. Due to the patient’s age and medical comorbidities, ­endovascular repair was the sole treatment option offered to the patient, who subsequently consented to the procedure.

R. Jamjoom ( )

McGill University, Montreal, QC, Canada