case_images: PMC7376372_01
case_images: (A) Saccular aneurysms of the descending aorta after subacute aortic dissection type B,
  (B) successful treatment with TEVAR, (C) type Ib endoleak 5 months after the first
  TEVAR, (D) CT-finding after additional TEVAR toward distal, (E) CT examination after
  hemoptysis revealed type II endoleak, and (F) zone 0 TEVAR with chimney method in the
  brachiocephalic trunk. CT indicates computer tomography; TEVAR, thoracic endovascular
  aortic repair.
case_images: 10.1177_1179547620939078-fig1.jpg
case_images: PMC7376372_02_10.1177_1179547620939078-fig1.jpg
case_images: fig1-1179547620939078
case_images: Immediate CT showed enlargement of the aneurysm with suspected type II endoleak (Figure 1E), but no extravasation into the bronchial system or lung parenchyma were observed. TEVAR was performed (Figure 1F). The procedure extended the proximal length with zone 0 landing (cTAG 45 mm x 2000 mm, Gore medical), and included an extra-anatomical bypass between the right and left axillary artery (Propaten, 8 mm, Gore medical) and chimney stenting into the brachiocephalic trunk (Excluder leg 20 mm x 1000 mm, Gore medical).
case_images: PMC7376372_02
case_images: (A) Saccular aneurysms of the descending aorta after subacute aortic dissection type B,
  (B) successful treatment with TEVAR, (C) type Ib endoleak 5 months after the first
  TEVAR, (D) CT-finding after additional TEVAR toward distal, (E) CT examination after
  hemoptysis revealed type II endoleak, and (F) zone 0 TEVAR with chimney method in the
  brachiocephalic trunk. CT indicates computer tomography; TEVAR, thoracic endovascular
  aortic repair.
case_images: 10.1177_1179547620939078-fig1.jpg
case_images: PMC7376372_02_10.1177_1179547620939078-fig1.jpg
case_images: fig1-1179547620939078
case_images: Immediate CT showed enlargement of the aneurysm with suspected type II endoleak (Figure 1E), but no extravasation into the bronchial system or lung parenchyma were observed. TEVAR was performed (Figure 1F). The procedure extended the proximal length with zone 0 landing (cTAG 45 mm x 2000 mm, Gore medical), and included an extra-anatomical bypass between the right and left axillary artery (Propaten, 8 mm, Gore medical) and chimney stenting into the brachiocephalic trunk (Excluder leg 20 mm x 1000 mm, Gore medical).
case_images: PMC7376372_03
case_images: (A) Macroscopic finding of the left lung. No aortobronchial fistula was observed and
  (B) hematoxylin and eosin staining of the left lung. Massive inflammation with bleeding
  in the parenchyma was observed.
case_images: 10.1177_1179547620939078-fig2.jpg
case_images: PMC7376372_03_10.1177_1179547620939078-fig2.jpg
case_images: fig2-1179547620939078
case_images: Because it was uncertain whether the upper lobe adjacent to the aortic arch was the sole source of the lung bleeding, and intraoperative findings indicated rather the whole left lung to be affected than a localized lesion, we ultimately finished with a pneumonectomy (Figure 2A). ABFs; there was very severe diffuse inflammatory change in the upper lobe and severe inflammatory change in the lower lobe (Figure 2B) as well. After the pneumonectomy, no lung bleeding occurred and the patient could be weaned off the veno-venous ECMO 5 days after the operation, and extubated on the 20th postoperative day.