Case Report Stent-graft Repair of a True Internal Thoracic Artery Aneurysm Gabriele Piffaretti, 1 Gianpaolo Carrafiello, 2 Marco Franchin, 1 Anna Maria Ierardi, 2 Giovanni Mariscalco, 3 Patrizio Castelli, 1 and Santi Trimarchi, 4 Varese and San Donato Milanese, Italy We present the case of a 49-year-old woman diagnosed with Sneddon’s syndrome and previous endovascular embolization for cerebral and left renal artery aneurysms. The aneurysm was asymptomatic and incidentally detected as coin opacity at a preoperative X-ray performed for breast surgery. The 13-mm saccular left internal thoracic artery aneurysm engaged through a percutaneous left brachial artery access was successfully excluded with a stent graft. A 6-month follow-up computed tomography angiography confirmed the exclusion of the aneurysm, the patency of the internal thoracic artery, and the absence of endoleak or edge stenoses. True aneurysm of the internal thoracic artery is a rare entity. Stent-graft repair is a viable end effective alternative treatment for the exclusion of this lesion. Aneurysm of the internal thoracic artery (ITA) is a rare entity; mainly, they have been identified as pseudoaneurysm following cardiac surgery, pacemaker implantation, or angiographic proce- dures. 1 True aneurysms of the ITA have been reported more rarely, especially in association with connective tissue diseases or vasculitis. 1e4 Traditionally, they have been treated with aneurys- mectomy, while endovascular techniques have been successfully used but mainly in the form of coils embolization. 4,5 We report the case of an ITA aneurysm successfully treated with stent graft (SG). CASE REPORT A 49-year-old woman with a known diagnosis of Sned- don’s syndrome was admitted to our hospital for the management of an ITA aneurysm. Medical history was also notable for hypertension, pituitary adenoma, previ- ous appendectomy, and colonic resection for diffuse acute peritonitis. In the past, she also underwent endo- vascular embolization of a left cerebral and left renal ar- tery aneurysms; at that time, a preoperative computed tomography angiography (CTA) did not show enlarge- ment of the ITA (Fig. 1A1). Three years later, she was admitted to our hospital for treatment of breast tumor as a result of screening program. A preoperative chest X-ray showed a left parasternal opacity which was further investigated with CTA. It revealed the presence of an intact 13-mm saccular aneurysm involving the proximal third of the left ITA (Fig. 1A2, B) and the dila- tation of the ascending aorta (Fig. 1A3). A transthoracic echocardiography also showed the presence of a compe- tent bicuspid aortic valve. A traditional open repair Funding: None. Conflict of Interest: None. 1 Vascular Surgery, Department of Surgery and Morphological Sci- ences, Circolo University Hospital, University of Insubria School of Med- icine, Varese, Italy. 2 Interventional Radiology, Department of Surgery and Morpholog- ical Sciences, Circolo University Hospital, University of Insubria School of Medicine, Varese, Italy. 3 Cardiac Surgery, University of Leicester, Glenfield Hospital, Leicester, UK. 4 Thoracic Aortic Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy. Correspondence to: Gabriele Piffaretti, MD, PhD, Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Hospital, University of Insubria School of Medicine, Via Guicciardini, 9, 21100 Varese, Italy; E-mail: gabriele.piffaretti@uninsubria.it Ann Vasc Surg 2015; -: 1–5 http://dx.doi.org/10.1016/j.avsg.2015.04.072 Ó 2015 Elsevier Inc. All rights reserved. Manuscript received: January 31, 2015; manuscript accepted: April 7, 2015; published online: ---. 1