PMC3569571_01
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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F1
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).
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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F2
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).
Thoracic aorta angiography after successful exclusion of thoracic aortic aneurysm by implantation of stent-grafts.
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F3
An immediate post-implant aortography showed no significant endoleak (Fig. 3).
One-month follow-up computed tomography images of thoracic aorta presenting a TAA completely excluded by stenting graft. A: horizontal plane image. B: three-dimensional reconstructed image. SVC: superior vena cava, RCCA: right common carotid artery, LCCA: left common carotid artery, TAA: thoracic aortic aneurysm, T: trachea, E: esophagus, ARSA: aberrant right subclavian artery, LSA: left subclavian artery, AA: ascending aorta, DA: descending aorta.
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F4
The patient was discharged in good status 5 days after the stent graft procedure and in the subsequent 2 years has remained well with no complications (Fig. 4).