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

Abstract

We review the cases of four patients with aneurysms of the aortic arch vessels and their branches. Two patients had a subclavian artery aneurysm, one had an innominate artery aneurysm, and one had a carotid artery aneurysm. We performed surgical reconstruction in all four patients in view of the life-threatening complications of these aneurysms. The approach, methods of surgical repair, and cerebral protection are discussed following these four case reports.

Surgical Reconstruction for Intrathoracic Aneurysm Originating from Proximal Part of the Right Subclavian Artery

“…Currently, it appears that arterial graft interposition or primary end-to-end anastomosis is common subsequent to aneurysmal resection. 2) We reconstructed the brachiocephalic and right common carotid arteries and bypassed to the distal part of the right subclavian artery because of the following reasons: First, the aneurysm extended from the origin of the subclavian artery (the innominate bifurcation); in this situation, it was difficult to reconstruct only the right subclavian artery because the proximal anastomotic neck could not be preserved. Second, the aneurysm was adhesive and large, so the distal anastomosis site of the subclavian artery could not be mobilized to anastomose in an endto-end fashion from sternotomy and supraclavicular sides.…”

“…1) The surgical procedure and approach depend on the size and location of the aneurysms. 2) We experienced a surgical case of intrathoracic aneurysm originating from the proximal part of the right subclavian artery. We discuss the relation between the location of an aneurysm and the surgical procedure.…”