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

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 100 mmHg pressure gradient between the aorta and BCA. Intravascular ultrasonography revealed stenosed BCA with a cord-like structure, which was considered a graft protrusion. Bare metal stenting was performed, promptly resolving the symptoms.