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

• Lee JH
• Ko YG
• Yoon YN
• Choi D
• Lee DY

• KMID: 1723005
• DOI: http://doi.org/10.4070/kcj.2013.43.1.66

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

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  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.

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  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.

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

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  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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