Open Stent Grafting for Aortic Arch Aneurysm with an Aberrant Right Subclavian Artery

Shinnosuke Goto＊	Hiroshi Mitsuoka＊	Masanao Nakai＊
Takahiro Suzuki＊	Shinji Kawaguchi＊	Daisuke Uchiyama＊
Yuta Miyano＊	Muneaki Yamada＊	Yasuhiko Terai＊
Ryouta Nomura＊

(Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital＊, Shizuoka, Japan)

We report a case of a 56-year-old woman. She had a history of emergent ascending aorta replacement due to type A dissection. Seven years later, aortic arch enlargement (55 mm) was detected on CT scan, and indicated secondary repair. Because of the existence of the aberrant right subclavian artery (ARSA), the safer surgical management needed to be discussed. Total arch replacement with the use of open stent-grafting technique and extra-anatomical reconstruction of ARSA was chosen for the treatment. In the operation, straight woven grafts (7 mm in diameter) were firstly anastomosed to the bilateral axillary arteries. Deep hypothermic circulatory arrest with antegrade cerebral perfusion through median sternotomy was established. The aortic arch was transected between the right and left subclavian arteries. The left subclavian artery was ligated at its origin, and an aortic open stent graft was inserted distally. An aortic reconstruction was performed between the left common carotid artery and the left subclavian artery with a 4 branched J-graft. The left carotid artery was reconstructed anatomically, and the tube grafts anastomosed to the bilateral axillary arteries were reconstructed in an extra-anatomical fashion. On the 11th postoperative days, coil-embolization of the ARSA was performed to complete the treatment. The patient had an uneventful post-operative recovery. Total arch replacement using an open stent-grafting technique was a feasible treatment option for the aortic arch aneurysm with ARSA.

 

Jpn. J. Cardiovasc Surg. 51: 359-362 （2022）

Keywords：open stent grafting; aberrant right subclavian artery; aortic arch aneurysm