Intrathoracic Aneurysm of the Innominate and Right Subclavian Arteries: Report of a Case

Abstract

Aneurysms of the innominate and subclavian arteries are uncommon but associated with high mortality rates. We report herein the case of a 45-year-old man who presented with facial anhidrosis that developed several years after blunt thoracic trauma, in whom an aneurysm involving the innominate and subclavian arteries was revealed by preoperative examinations. Resection of the aneurysm and reconstruction from the ascending aorta to both the subclavian and common carotid arteries using a bifurcated graft was successfully performed without brain perfusion. Although the left posterior cerebral artery, which was not manipulated during surgery, became occluded, it was recanalized by thrombolysis. The patient was discharged in good health and has remained well since.

Surgical Management of Aneurysms of the Aortic Arch Vessels and Their Branches: Report of Four Cases

“…The embo- lism to the upper extremities and the brain can result in ischemic symptoms, and embolization is possible, even from small aneurysms associated with mural thrombus. [6][7][8] Nonetheless, IAA often presents as an asymptomatic superior mediastinal mass on a routine chest X-ray. 8 Physical examination revealed pulsatile masses in two of our patients (one in the supraclavicular space and the other in the neck), and a systolic bruit in another patient.…”

“…Thus, several techniques have been developed to avoid neurological injuries and preserve cerebral function during aortic clamping. 5,6,19 Continuous antegrade cerebral perfusion via the distal IA and hypothermia offer adequate protection during circulatory arrest in patients undergoing replacement of the aortic arch vessels. 20, 21 We use selective antegrade cerebral perfusion during aortic arch vessel reconstruction, and find it a reliable technique for brain protection.…”

“…A review of the literature reveals several different surgical approaches. 6,8,14,15 For an SAA, the surgical management depends on the intrathoracic or extrathoracic location and the size, and may involve a supraclavicular or infraclavicular approach for a right SAA, a thoracotomy through an anterolateral incision in the left fourth intercostal space for a left-sided lesion, or a median sternotomy (with or without supraclavicular and intercostal extension) for optimal proximal exposure. 16 Contemporary surgical repair of an SAA involves resection and re-establishment of arterial continuity with an end-toend anastomosis, for small aneurysms, or more commonly, an interposition arterial prosthesis.…”

“…The only form of treatment is surgical intervention. 5, 6 We report four cases of aortic arch vessel aneurysms: two right subclavian artery aneurysms (SAA), one innominate artery aneurysm (IAA), and one right common carotid artery aneurysm (CCAA), and discuss the surgical treatment and methods of cerebral protection used.…”

Hybrid management of proximal right subclavian artery aneurysms

“…They typically require a combined mediastinal exposure 1 to control the innominate and right common carotid arteries and a supraor infraclavicular exposure for distal control, with either a segmental resection and bypass or a bifurcated reconstruction. 2 In this report, we present a case series utilizing a single-stage, hybrid technique combining a stent graft and an extra-anatomical bypass to repair proximal RSCA aneurysms without the need for mediastinal exposure or extensive surgical reconstruction.…”