Hybrid treatment of a true thyreocervical trunk aneurysm in a patient with Type B aortic dissection.
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Date
2016-04
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Abstract
We would like to describe a case with a complex aortic disease treated in hybrid fashion. We present an
interesting case of a 65‑year‑old man with a medical history of hypertension, hyperlipidemia, and coronary
artery disease percutaneously treated. An acute Type B aortic dissection occurred and treated with the
implantation of a stent‑graft which occluded the left subclavian artery due to its extension to the aortic
arch. This event required a carotid‑subclavian artery bypass due to ischemia of the left arm. An aneurysm
in the innominate artery also detected, was treated with another stent‑graft implantation 3 months later.
At 5‑year follow‑up, an aneurysm of the thyreocervical trunk was found while the stent‑graft of the aorta
was well‑tolerated without endoleak and the carotid‑subclavian graft was patent. The aneurysm was
asymptomatic but considering the risk of spontaneous rupture of an aneurysm of this size, elective surgery
was indicated. Because the aneurysm was very close to the brachiocephalic bifurcation, open surgical repair
would require a sternotomy. The right common carotid artery and right subclavian artery were exposed. The
thyrocervical trunk, right internal mammary artery and right vertebral artery were occluded by ligations to
isolate the aneurysm. An 8‑mm Dacron graft was anastomosed end‑to‑end to the distal part of subclavian
artery. We would like through this case, discuss the role of the hybrid cardiovascular surgery to minimize
the postoperative complications in complex cardiovascular pathology. We also discuss the international
bibliography about the thyreocervical trunk aneurysm and the treatment options.
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Keywords
Acute aortic syndrome, Aortic dissection, Cerebral artery perfusion, Hybrid aortic surgery, Hybrid cardiovascular surgery, Hypoplastic vertebral artery, Subclavian artery aneurysm, Thyreocervical trunk aneurysm, Type B aortic dissection
Citation
Baikoussis Nikolaos G, Argiriou Orestis, Argiriou Michalis, Psevdi Aikaterini, Kratimenos Theodoros, Dedeilias Panagiotis. Hybrid treatment of a true thyreocervical trunk aneurysm in a patient with Type B aortic dissection. Annals of Cardiac Anaesthesia. 2016 Apr; 19(2): 363-366.