Surgical Treatment for Aortic Arch Aneurysm Complicated with Aberrant Right Subclavian Artery / 日本心臓血管外科学会雑誌

ABSTRACT

Three cases of aortic arch aneurysm complicated by aberrant right subclavian artery (ARSA) are reported. Two patients underwent emergent operations with diagnosis of a Stanford type A acute dissection and a ruptured distal arch aneurysm. The third patient underwent an elective operation under a diagnosis of distal arch aneurysm and right subclavian artery aneurysm. In all cases, deep hypothermic circulatory arrest with retrograde cerebral perfusion through median sternotomy was applied. The first patient with acute aortic dissection underwent total arch replacement and elephant trunk installation into the descending aorta. No ARSA was recognized. The other 2 patients underwent distal arch replacement with reconstruction of bilateral subclavian arteries. The <i>in-situ</i> reconstruction of the ARSA was performed in one patient and bypass grafting from the ascending aorta was done in the other patient. There were 2 hospital deaths. The postoperative angiogram of the first patient showed that the ARSA was occluded. One other patient needed a tracheostomy because of pulmonary complications and he died of asphyxia. The last patient died of esophageal perforation secondary to pressure necrosis.