J Korean Surg Soc.  2012 Mar;82(3):195-199. 10.4174/jkss.2012.82.3.195.

A hybrid operation in a patient with complex right subclavian artery aneurysm

• Roh YN
• Park KB
• Do YS
• Kim WS
• Kim YW
• Kim DI

• KMID: 2212223
• DOI: http://doi.org/10.4174/jkss.2012.82.3.195

Abstract

We report a hybrid surgery including endovascular aneurysm repair and debranching procedures to treat a patient with a complex right subclavian artery aneurysm. The patient was a 70-year-old woman who presented with dry cough and hoarseness. The aneurysm was characterized by the absence of a proximal neck, and involvement of the origin of the right vertebral artery. She underwent carotid-vertebral artery bypass, stent graft from the innomiate artery to the common carotid artery and carotid-axillary artery bypass. Great saphenous vein was used for the carotid-vertebral artery bypass and 7 mm reinforced polytetrafluoroethylene graft was used for the carotid-axillary artery bypass. The postoperative course was uneventful.

Keyword

Subclavian artery; Aneurysm; Hybrid operation

MeSH Terms

Aged
Aneurysm
Arteries
Carotid Artery, Common
Chimera
Cough
Female
Hoarseness
Humans
Neck
Polytetrafluoroethylene
Saphenous Vein
Stents
Subclavian Artery
Transplants
Vertebral Artery
Polytetrafluoroethylene

Figure

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  Fig. 1 The preoperative (A-C) and postoperative (D-F) computed tomography angiography.

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  Fig. 2 Preoperative plan of the hybrid surgery. (A) The anatomy of the right subclavian artery aneurysm. (B) Right common carotid-vertebral bypass with the great saphenous vein graft. (C) Proximal anastomosis of the right common carotid-axillary bypass with a 7 mm ringed polytetrafluorethylene (PTFE) graft. (D) Stent graft from the innominate artery to the right common carotid artery via the PTFE graft. (E) Coil embolization of the branches. (F) Distal anastomosis of the right common carotid artery-right axillary artery and ligation of the axillary artery. Rt., right; VA, vertebral artery; CCA, common carotid artery.

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  Fig. 3 Intra-operative pictures of the hybrid surgery. (A) Exposure of the right common carotid artery and right vertebral artery (blue arrow, carotid artery; green arrow, vertebral artery; black arrow, vagus nerve). (B) Right common carotid-vertebral bypass with the great saphenous vein (GSV) graft (black arrow, GSV graft; blue arrow, carotid shunt). (C) Proximal anastomosis of the right common carotid-axillary bypass (black arrow). (D) Reloading of the stent graft. (E) The stent graft from the innominate artery to the right common carotid artery (black arrow). (F) Distal anastomosis of the right common carotid artery-right axillary artery (blue arrow, right common carotid-vertebral bypass with the GSV graft; green arrow, right common carotid-axillary bypass with polytetrafluoroethylene graft).

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