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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

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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Figure 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.

Mentions: We decided to perform a staged hybrid procedure combining surgical replacement of the ascending aorta and bilateral carotid-tosubclavian artery bypass with implantation of a stent graft in aortic arch and descending aorta. In the first stage of the procedure, the ascending aorta was replaced by a graft. Under general anesthesia, median sternotomy was performed. Cardiopulmonary bypass was performed after cannulation of the right axillary artery and the right atrium. The ascending aorta was clamped and the heart was arrested with cold antegrade cardioplegia infusion. After selective antegrade cerebral perfusion was started, the ascending aorta was replaced using 4-branched hemashield graft (28, 10, 8, 8, 10 mm, Boston Scientific, Wayne, NJ, USA). Two 10 mm graft branches were ligated. The other two 8 mm graft branches were anastomosed with each of the common carotid arteries. The cardiopulmonary bypass, aortic across clamp, and circulatory arrest time was 162, 87, and 15 minutes, respectively. For securing a sufficient landing zone for stent graft implantation, the distal end of the hemashield graft was inserted into distal aortic arch as an elephant trunk. In our patient, the elephant trunk is attached to the proximal aorta arch after debranching and bypassing both common carotid arteries from the hemashield graft of ascending aorta in order to exclude dilated aorta arch distal to the origins of the left and right subclavian arteries (Fig. 2).


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)

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

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

Figure 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.
Mentions: We decided to perform a staged hybrid procedure combining surgical replacement of the ascending aorta and bilateral carotid-tosubclavian artery bypass with implantation of a stent graft in aortic arch and descending aorta. In the first stage of the procedure, the ascending aorta was replaced by a graft. Under general anesthesia, median sternotomy was performed. Cardiopulmonary bypass was performed after cannulation of the right axillary artery and the right atrium. The ascending aorta was clamped and the heart was arrested with cold antegrade cardioplegia infusion. After selective antegrade cerebral perfusion was started, the ascending aorta was replaced using 4-branched hemashield graft (28, 10, 8, 8, 10 mm, Boston Scientific, Wayne, NJ, USA). Two 10 mm graft branches were ligated. The other two 8 mm graft branches were anastomosed with each of the common carotid arteries. The cardiopulmonary bypass, aortic across clamp, and circulatory arrest time was 162, 87, and 15 minutes, respectively. For securing a sufficient landing zone for stent graft implantation, the distal end of the hemashield graft was inserted into distal aortic arch as an elephant trunk. In our patient, the elephant trunk is attached to the proximal aorta arch after debranching and bypassing both common carotid arteries from the hemashield graft of ascending aorta in order to exclude dilated aorta arch distal to the origins of the left and right subclavian arteries (Fig. 2).

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