PMC9294322_01
(A) Chest X-ray showed an intrathoracic mass in the upper lobe of the right lung and displacement of the trachea to the left (white arrow). (B,C) Computed tomography angiography (CTA) revealed a giant right subclavian artery aneurysm (SAA) with partial intraluminal thrombus and severe angulated aneurysm necks (white arrow).
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F1
A chest X-ray showed an intrathoracic mass in the upper lobe of the right lung and displacement of the trachea to the left (Figure 1A). Computed tomography angiography (CTA) revealed a giant right subclavian artery aneurysm (SAA) with partial intraluminal thrombus and severe angulated aneurysm necks originating from the proximal right subclavian artery, approximately 70 x 71 mm in size (Figures 1B, C).
(A) Selective angiography via the left femoral artery verified the CTA findings. (B) The guidewire was circled along the shape of the aneurysm instead of along the shortest path. (C) The tip of the guide wire was introduced into a sheath placed in the femoral artery. (D) The guidewire was held out of the body, thus creating a through-and-through guide wire (black arrows). (E) The stent graft smoothly advanced to the intended position, 20 mm away from the orifice of the right subclavian artery. (F) Final angiography showed that the SAA was essentially excluded, although a slight endoleak was also observed.
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F2
The distal subclavian artery was located at the lower back of the aneurysm, and the proximal and distal aneurysm necks presented with a type Z distortion (Figure 2A). Because the aneurysm cavity was large, and the neck of the aneurysm was angulated, the guide wire was circled along the shape of the aneurysm instead of along the shortest path; after it was straightened, it bounced back (Figure 2B). Then, the tip of the guide wire was introduced into a 7-Fr introducer sheath placed in the femoral artery (Figure 2C). The guide wire was held outside of the body, thus creating a through-and-through guide wire (Figure 2D). Two doctors held the ends of the guidewire in the two access sheaths and maintained the tension, and the third doctor advanced the stent graft smoothly without obvious resistance to the intended position, 2 cm away from the orifice of the right subclavian artery (Figure 2E). Final angiography showed that the SAA was essentially excluded and that the flow of the right vertebral artery was preserved, and slight endoleak was observed, which appeared to arise from the inflexion of the stent graft (Figure 2F).
(A) CTA after 1 week indicated that the SAA was essentially occluded with a patent stent graft, and thrombus formation was observed in the aneurysm (white arrow). (B) At the 6-month follow-up, the aneurysm was not obviously shrinking, and CTA revealed that there was still an endoleak into the aneurysmal sac (white arrow). (C,D) Angiography revealed no contrast material leakage through the fabric of the inflexion of the stent graft, confirming a type Ia endoleak and the stent graft was caudally displaced. (E) Angiography showed successful exclusion of the aneurysm, with the absence of a type I endoleak. (F) At the 25-month follow-up, CTA revealed no evidence of an endoleak into the aneurysmal sac, and the stent graft was patent.
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F3
CTA after 1 week indicated that the SAA was essentially occluded by the patent stent graft, and thrombus formation was observed in the aneurysm (Figure 3A). At the 6-month follow-up, the aneurysm was not obviously shrinking, and CTA revealed that there was still an endoleak into the aneurysmal sac (Figure 3B). Angiography revealed no contrast material leakage through the fabric of the inflexion of the stent graft, confirming a type Ia endoleak (Figures 3C, D) and the stent graft was caudally displaced. Angiography showed the successful exclusion of the aneurysm, with the absence of a type I endoleak (Figure 3E). At the 25-month follow-up, CTA revealed no evidence of endoleak, complete thrombosis and that the SAA had decreased to 66 x 60 mm (Figure 3F).
A timeline with relevant information from this case. RAAA: right SAA.
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F4
A timeline with relevant information from this case is shown in Figure 4.