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J Vasc Surg. 2013 Apr;57(4):1116-9. doi: 10.1016/j.jvs.2012.09.067. Epub 2013 Jan 9.

Treatment of a patient with vertebral and subclavian aneurysms in the setting of a TGFBR2 mutation.

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Department of Vascular and Endovascular Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.


We present the case of a patient diagnosed with hypermobile Ehlers-Danlos syndrome with aneurysms of the subclavian and vertebral arteries. Molecular testing demonstrated transforming growth factor-beta receptor type 2 mutation. She was not a candidate for an open repair; therefore, a hybrid approach involving right vertebral ligation and bypass from the right common carotid to the vertebral C1-2 interface, endovascular exclusion of the left vertebral artery, and stent grafting of the left subclavian/axillary artery was used. The left vertebral embolization proved ineffective, requiring a right-to-left vertebral catheterization with glue occlusion. Based on her proper molecular diagnosis, she underwent prophylactic root and ascending aortic repair.

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