# Jaw claudication and branch perfusion reduction as rare complications of fenestrated thoracic endovascular aortic repair

## TL;DR

A patient developed jaw pain and reduced blood flow after a rare aortic repair procedure, which was later resolved with stenting.

## Contribution

This case highlights jaw claudication and perfusion reduction as rare complications of fenestrated thoracic endovascular aortic repair.

## Key findings

- Jaw claudication and hypotension occurred after fenestrated aortic repair.
- Angiography showed a flap-like structure and pressure gradient in the brachiocephalic artery.
- Bare metal stenting resolved the symptoms and stenosis.

## Abstract

We report a rare case of jaw claudication following fenestrated thoracic endovascular aortic repair for a saccular aortic arch aneurysm. The brachiocephalic artery (BCA) was preserved with fenestration and intentionally half covered. Although discharged without any complications 2 weeks after the procedure, the patient subsequently experienced right mandibular fatigue at mealtime and hypotension in the right upper extremity. Angiography revealed a flap-like structure in the BCA orifice, with a 100-mm Hg pressure gradient between the aorta and BCA. Intravascular ultrasound revealed a stenosed BCA with a cord-like structure, which was considered a graft protrusion. Bare metal stenting was performed, which promptly resolved the symptoms.