Korean Circ J.  2013 Jan;43(1):66-69. 10.4070/kcj.2013.43.1.66.

Hybrid Treatment for Thoracic Aortic Aneurysm Combined with Aberrant Right Subclavian Artery

Affiliations
  • 1Division of Cardiology, Yonsei University College of Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea. ygko@yuhs.ac
  • 2Division of Cardiovascular Surgery, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 3Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.

Abstract

An aberrant right subclavian artery (ARSA) is the most common vascular abnormality of the aortic arch and is associated with development of aneurysms in 3-8% of these anomalies. In this case report, we describe an 84-year-old man with a symptomatic ARSA treated with staged hybrid procedure combining surgical replacement of the ascending aorta and bilateral carotid-to-subclavian artery bypass with implantation of a stent graft in the aortic arch and descending aorta. Our case suggests that a less invasive hybrid therapy can be performed successfully for the treatment of ARSA with aneurysmal change in patients at high surgical risk.

Keyword

Aberrant right subclavian artery; Aortic aneurysm, thoracic; Endovascular procedures

MeSH Terms

Aneurysm
Aorta
Aorta, Thoracic
Aortic Aneurysm, Thoracic
Arteries
Cardiovascular Abnormalities
Endovascular Procedures
Humans
Stents
Subclavian Artery
Transplants
Aneurysm
Cardiovascular Abnormalities
Subclavian Artery

Figure

  • Fig. 1 Thoracic aortic aneurysm with an aberrant right subclavian artery. A: three-dimension reconstructed computed tomography images. B: aberrant right subclavian artery between esophagus and trachea. AA: ascending aorta, DA: descending aorta, ARSA: aberrant right subclavian artery, RCCA: right common carotid artery, LCCA: left common carotid artery, LSA: left subclavian artery, TAA: thoracic aortic aneurysm, T: trachea, E: esophagus, SVC: superior vena cava.

  • Fig. 2 Illustration of staged surgical procedures for replacement of ascending aorta with bypass to bilateral carotid arteries, attachment of elephant trunk, and bilateral carotid-to-subclavian bypass. A: pre-op. B: post-op. AA: ascending aorta, TAA: thoracic aortic aneurysm, ARSA: aberrant right subclavian artery, LSA: left subclavian artery, RCCA: right common carotid artery, LCCA: left common carotid artery, HG: hemashield graft.

  • Fig. 3 Thoracic aorta angiography after successful exclusion of thoracic aortic aneurysm by implantation of stent-grafts.

  • Fig. 4 One-month follow-up computed tomography images of thoracic aorta presenting a TAA completely excluded by stenting graft. A: horizontal plane image. B: three-dimensional reconstructed image. SVC: superior vena cava, RCCA: right common carotid artery, LCCA: left common carotid artery, TAA: thoracic aortic aneurysm, T: trachea, E: esophagus, ARSA: aberrant right subclavian artery, LSA: left subclavian artery, AA: ascending aorta, DA: descending aorta.


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