Staging Surgery for The Treatment of Aortic Arch Aneurysm Combined with Aberrant Bilateral Subclavian Artery, Persistent Left Superior Vena Cava and Airway Compression: A Case Report
DOI:
https://doi.org/10.1532/hsf.2613Abstract
Background: To describe staging surgery for the treatment of a patient with aortic arch aneurysm combined with aberrant bilateral subclavian artery, persistent left superior vena cava (PLSVC), and airway compression.
Case report: A 42-year-old female was hospitalized for aortic arch aneurysm involving aberrant bilateral subclavian artery, PLSVC, and airway compression. The patient's aneurysm was successfully treated by stage I surgery, including total aortic arch replacement and stented elephant trunk procedure and stage II surgery, including tracheal stenting and tracheotomy. Aortic CTA examination showed an unobstructed lumen and a good stent position without tracheal stent migration. Regular postoperative follow-up showed no complications, such as dyspnea, cough, and sputum, or other discomfort symptoms.
Conclusions: Total aortic arch replacement, elephant trunk surgery, and second-stage tracheal stent surgery are effective and safe for the treatment of aortic arch aneurysm combined with aberrant bilateral subclavian artery, PLSVC, and airway compression.
References
Arima H, Sobue K, Tanaka S et al. 2002. Airway obstruction associated with transesophageal echocardiography in a patient with a giant aortic pseudoaneurysm. Anesth Analg. 95:558-60, table of contents.
Bickerstaff LK, Pairolero PC, Hollier LH et al. 1982. Thoracic aortic aneurysms: a population-based study. Surgery. 92:1103-8.
Borst HG, Walterbusch G, Schaps D. 1983. Extensive aortic replacement using "elephant trunk" prosthesis. Thorac Cardiovasc Surg. 31:37-40.
Chau KH, Elefteriades JA. 2013. Natural history of thoracic aortic aneurysms: size matters, plus moving beyond size. Prog Cardiovasc Dis. 56:74-80.
Chokr MO, de Moura LG, Aiello VD et al. 2018. Atrioventricular nodal reentrant tachycardia and persistent left superior vena cava: A tough nut to crack. Successful ablation with transseptal approach. HeartRhythm Case Rep. 4:589-93.
Crawford ES, Crawford JL, Stowe CL et al. 1984. Total aortic replacement for chronic aortic dissection occurring in patients with and without Marfan's syndrome. Ann Surg. 199:358-62.
Crawford ES, Svensson LG, Coselli JS et al. 1989. Surgical treatment of aneurysm and/or dissection of the ascending aorta, transverse aortic arch, and ascending aorta and transverse aortic arch. Factors influencing survival in 717 patients. J Thorac Cardiovasc Surg. 98:659-73; discussion 73-4.
Gu X, Li S, Zhao F et al. 2001. Pacemaker leads were implanted in patients with persistent left superior vena cava and absent right superior vena cava.
Ince H, Nienaber CA. 2007. Etiology, pathogenesis and management of thoracic aortic aneurysm. Nat Clin Pract Cardiovasc Med. 4:418-27.
Kato M, Ohnishi K, Kaneko M et al. 1996. New graft-implanting method for thoracic aortic aneurysm or dissection with a stented graft. Circulation. 94:Ii188-93.
Kato M, Kuratani T, Kaneko M et al. 2002. The results of total arch graft implantation with open stent-graft placement for type A aortic dissection. J Thorac Cardiovasc Surg. 124:531-40.
Khalil A, Helmy T, Porembka DT. 2007. Aortic pathology: aortic trauma, debris, dissection, and aneurysm. Crit Care Med. 35:S392-400.
Kim T, Martin TD, Lee WA et al. 2009. Evolution in the management of the total thoracic aorta. J Thorac Cardiovasc Surg. 137:627-34.
Sabra O, Sabri A, Sfeir P. 2006. Airway obstruction secondary to thoracic aortic aneurysm leak. A case report. Eur Arch Otorhinolaryngol. 263:1144-6.
Xiong J, Zhang M, Guo W et al. 2013. Early malperfusion, ischemia reperfusion injury, and respiratory failure in acute complicated type B aortic dissection after thoracic endovascular repair. J Cardiothorac Surg. 8:17.
