Aberrant right subclavian artery re-routing for hybrid repair of proximal descending aortic aneurysm
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(2018) 13:130
CASE REPORT
Open Access
Aberrant right subclavian artery re-routing for hybrid repair of proximal descending aortic aneurysm Tae Yun Kim1* and Kyung Hwa Kim1,2*
Abstract Background: An aberrant right subclavian artery (ARSA) is a relatively prevalent vascular anomaly. What is the most appropriate treatment for thoracic aortic aneurysm combined a non-aneurysmal change ARSA? Case presentation: A 52-year-old man was admitted to our institute due to a history of chronic cough, dysphagia and an abnormal chest radiographic finding. Because of his progressive symptoms and large fusiform thoracic aneurysm, we performed the hybrid repair for simultaneous relief of an ARSA causing dysphagia and thoracic aneurysm. Conclusion: In case without aneurysm of ARSA, especially in conjunction with approximate thoracic aneurysm, our approach is suitable because the revascularization using the right carotid to subclavian artery re-routing prior to endograft deployment is justified in order to preserve circulation of posterior brain, spinal cord, internal mammary artery and upper limb and to prevent large retrograde type II endoleaks, as well as simplicity and durability. Keywords: Aberrant right subclavian artery, Proximal descending aortic aneurysm
Background An aberrant right subclavian artery (ARSA) is a relatively prevalent vascular anomaly [1]. We considered several treatment options for throracic aortic aneurysm combined non-aneurysmal formation ARSA. For example, there were the isolated open surgery for thoracic aneurysm due to relatively young age, or selective thoracic endograft for simplicity, or occlusion the orifice of the aberrant right subclavian artery using an vascular plug and added a carotid-subclavian bypass / transposition via a supraclavicular incision. In the endovascular era, we presented the hybrid repair for simultaneous relief of an ARSA causing dysphagia and thoracic aneurysm. Case presentation A 52-year-old man was admitted to our institute due to a history of chronic cough, dysphagia and an * Correspondence: [email protected]; [email protected] 1 Department of Thoracic and cardiovascular surgery, Chonbuk National University Medical School, Chonbuk National University Hospital, 20 Geonji-Ro, Geumam-dong, Deokjin-gu, Jeonju 54907, Republic of Korea Full list of author information is available at the end of the article
abnormal chest radiographic finding. A chest x-ray and computed tomographic angiography scan (CTA) revealed an ARSA behind the esophagus with about 5.6-cm sized proximal descending aortic aneurysm (Fig. 1a). The esophagus was clearly compressed by the ARSA (Fig. 1b), likely causing the dysphagia. Both carotid arteries had a common origin. Because of his progressive symptoms and large fusiform thoracic aneurysm, we planned the hybrid repair for simultaneous relief of ARSA causing dysphagia and thoracic aneurysm. First, an ARSA to the right carotid artery transposition with a proximal ligation of the ARSA along distal to the right vertebral and mammary arteries was performed vi
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