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Hybrid treatment for thoracic aortic aneurysm combined with aberrant right subclavian artery.

Lee JH, Ko YG, Yoon YN, Choi D, Lee DY - Korean Circ J (2013)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Yonsei University College of Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, 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.

No MeSH data available.


Related in: MedlinePlus

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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Figure 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.

Mentions: An 84-year-old man presented with chest pain on left side. He was a smoker of 60 years' standing and had been previously diagnosed with hypercholesterolemia. However, he had no past history of hypertension or diabetes. A chest X-ray showed markedly dilated aortic notch. Computed tomography (CT) aortography revealed an ARSA originating from the distal aortic arch, distal to the left subclavian artery and crossing the mediastinum between esophagus and trachea, and a thoracic aortic aneurysm with a diameter of 67 mm and a thrombus extending from the left subclavian artery origin to the proximal descending aorta involving the right subclavian artery origin (Fig. 1). The ascending aorta was also dilated with a maximal diameter of 40 mm and showed partial calcification on the anterior aorta wall. Electrocardiogram was nonspecific. Echocardiography showed normal sized cardiac chambers with left ventricle ejection fraction of 74%. Thoracic aortography confirmed the CT findings. Coronary angiography demonstrated 50% narrowing of the proximal left anterior descending artery. CT brain also revealed that the circle of Willis and both vertebral arteries were patent. Results of laboratory tests showed elevated total serum cholesterol (237 mg/dL) and low density lipoprotein cholesterol levels (164 mg/dL).


Hybrid treatment for thoracic aortic aneurysm combined with aberrant right subclavian artery.

Lee JH, Ko YG, Yoon YN, Choi D, Lee DY - Korean Circ J (2013)

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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3569571&req=5

Figure 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.
Mentions: An 84-year-old man presented with chest pain on left side. He was a smoker of 60 years' standing and had been previously diagnosed with hypercholesterolemia. However, he had no past history of hypertension or diabetes. A chest X-ray showed markedly dilated aortic notch. Computed tomography (CT) aortography revealed an ARSA originating from the distal aortic arch, distal to the left subclavian artery and crossing the mediastinum between esophagus and trachea, and a thoracic aortic aneurysm with a diameter of 67 mm and a thrombus extending from the left subclavian artery origin to the proximal descending aorta involving the right subclavian artery origin (Fig. 1). The ascending aorta was also dilated with a maximal diameter of 40 mm and showed partial calcification on the anterior aorta wall. Electrocardiogram was nonspecific. Echocardiography showed normal sized cardiac chambers with left ventricle ejection fraction of 74%. Thoracic aortography confirmed the CT findings. Coronary angiography demonstrated 50% narrowing of the proximal left anterior descending artery. CT brain also revealed that the circle of Willis and both vertebral arteries were patent. Results of laboratory tests showed elevated total serum cholesterol (237 mg/dL) and low density lipoprotein cholesterol levels (164 mg/dL).

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Yonsei University College of Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, 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.

No MeSH data available.


Related in: MedlinePlus