Hybrid repair of an adult with a double aortic arch, coarctation of the aorta, and left subclavian artery aneurysm

Introduction: We present a case of a 70-year-old patient who underwent successful two-stage repair of an intrathoracic left subclavian artery aneurysm (SAA) and who had previously undergone CABG. Case presentation: The patient had previously undergone three-vessel coronary artery bypass graft (CABG) repair with the use of the left internal mammary artery (LIMA) to the left anterior descending artery (LAD). Percutaneous coronary intervention (PCI) was performed as a backup option in case of potential intra-operative LIMA-LAD bypass occlusion. Owing to the impossibility of hybrid repair due to a short proximal landing zone and aortic arch anomaly (bovine type), the vascular surgery review board decided to perform two-stage open surgery. Firstly, the patient underwent a left carotid-subclavian (C-S) bypass with the Dacron graft, with the application of the standard supraclavicular approach. After a few days, the second procedure, through the left posterolateral thoracotomy was performed. The left subclavian artery (SA) was ligated distally to the SAA but proximally to the origin of the LIMA. The distal aortic arch at the site of the left SAA was clamped partially and the aneurysm was excised. The defect of the aortic arch was sutured and reinforced with a felt patch. Postoperatively, the patient had a good recovery, without any signs of myocardial injury or any surgery-related issues. Conclusion: Careful planning and two-stage open surgical treatment of the left SAA, first with a left carotid-subclavian bypass, followed by aneurysm exclusion and suture of the outer aortic arch curvature may be a treatment option for patients not amenable to hybrid treatment.

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An aberrant left subclavian artery aneurysm with right aortic arch: Report of a case

Surgery Today ◽

10.1007/bf02483000 ◽

1999 ◽

Vol 29 (7) ◽

pp. 675-678 ◽

Cited By ~ 2

Author(s):

Masashi Muraoka ◽

Yoshitaka Uchiyama ◽

Norio Yamaoka ◽

Hideto Yamauchi ◽

Hiroshi Hashiyada ◽

...

Keyword(s):

Aortic Arch ◽

Subclavian Artery ◽

Left Subclavian Artery ◽

Artery Aneurysm ◽

Right Aortic Arch ◽

Aberrant Left Subclavian Artery ◽

Subclavian Artery Aneurysm

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Total Arch Replacement with Frozen Elephant Trunk Technique for Aortic Arch Aneurysm Complicated with Left Subclavian Artery Aneurysm

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.41.113 ◽

2012 ◽

Vol 41 (3) ◽

pp. 113-116 ◽

Cited By ~ 1

Author(s):

Taro Nakazato ◽

Teruya Nakamura ◽

Naosumi Sekiya ◽

Naomichi Uchida ◽

Yoshiki Sawa

Keyword(s):

Aortic Arch ◽

Subclavian Artery ◽

Left Subclavian Artery ◽

Artery Aneurysm ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Subclavian Artery Aneurysm ◽

Elephant Trunk Technique ◽

Arch Aneurysm ◽

Frozen Elephant Trunk Technique

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Dissecting left subclavian artery aneurysm: an unusual presentation of coarctation of the aorta

International Journal of Cardiology ◽

10.1016/0167-5273(93)90233-7 ◽

1993 ◽

Vol 40 (1) ◽

pp. 69-70 ◽

Cited By ~ 9

Author(s):

R.A. Henderson ◽

C. Ward ◽

C. Campbell

Keyword(s):

Subclavian Artery ◽

Left Subclavian Artery ◽

Artery Aneurysm ◽

Coarctation Of The Aorta ◽

Unusual Presentation ◽

Subclavian Artery Aneurysm

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Double trouble: A clinical case report of double aortic arch and aberrant location of left subclavian artery

Sonography ◽

10.1002/sono.12270 ◽

2021 ◽

Author(s):

Paula Kinnane

Keyword(s):

Case Report ◽

Aortic Arch ◽

Subclavian Artery ◽

Clinical Case ◽

Left Subclavian Artery ◽

Double Aortic Arch

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Study on the views and methods of ultrasonic screening and diagnosis for abnormal aortic arch in infants

Cardiovascular Ultrasound ◽

10.1186/s12947-021-00237-2 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Xinjian He ◽

Jiaoyang Chen ◽

Gaoyang Li

Keyword(s):

Diagnostic Accuracy ◽

Aortic Arch ◽

Subclavian Artery ◽

Coarctation Of The Aorta ◽

Double Aortic Arch ◽

Aberrant Right Subclavian Artery ◽

Coincidence Rate ◽

Aortic Arch Anomalies ◽

Screening Sensitivity ◽

Axis View

Abstract Background The purpose of this study was to explore echocardiographic views and methods of aortic arch anomalies in infants, so as to improve the screening sensitivity and diagnostic accuracy. Methods 140 children with abnormal aortic arch diagnosed by ultrasound in Children’s Hospital of Hebei Province from January 2014 to December 2019 were selected for retrospective analysis. All were confirmed by surgery or/and computerized tomography angiography. Series of views for aortic arch (the three-vessel and tracheal view, aortic arch short axis view, left aortic arch long axis view, aortic arch long axis continuous scan views) were performed in all cases on the basis of the routine views of echocardiography. The screening sensitivity and diagnostic coincidence rate of different echocardiographic views for aortic arch anomalies were analyzed. Results Among the 140 infants, right aortic arch were 21 cases (6/21 were accompanied by mirror branch and 15/21 were with aberrant left subclavian artery). Left aortic arch with aberrant right subclavian artery were 2 cases, and double aortic arch with both arches open were 20 cases. Double aortic arch with left arch atresia were 2 cases, and atresia of the proximal aorta with aortic arch dysplasia was 1 case. Coarctation of the aorta were 67 cases, and interruption of aortic arch were 27 cases. All the patients were correctly diagnosed except that 2 infants with interruption of aortic arch were incorrectly diagnosed as coarctation of the aorta, and 1 infant with coarctation of the aorta was misdiagnosed as interruption of aortic arch by echocardiography. The screening sensitivities of four views and four-view combination for abnormal aortic arch were 99.3, 73.6, 87.1, 99.3, and 100%; the diagnostic coincidence rates were 85.7, 27.1,66.4, 95.0%, and 97.9% respectively. On the basis of traditional left aortic long axis view, other three views had their own advantages. The screening sensitivity and diagnostic coincidence rate of four-view combination were significantly improved. Conclusions The three-vessel trachea view is simple and feasible, which is suitable for screening abnormal aortic arch. The combination of four views conduces to improving screening sensitivity and diagnostic accuracy of aortic arch abnormalities.

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