# Treatment of aortic arch and left subclavian artery aneurysms in two stages using combined surgical approaches: case report

## TL;DR

This case report describes a two-stage surgical treatment for a complex aortic arch aneurysm involving the left subclavian artery.

## Contribution

The paper presents a novel combined surgical approach for treating a complex aortic arch aneurysm with subclavian artery involvement.

## Key findings

- A two-stage surgical approach was successfully used to treat a complex aortic arch aneurysm.
- A Dacron graft was used to create a vascular conduit for stent graft delivery due to narrow femoral and iliac arteries.
- The patient had a satisfactory outcome following the complex surgical treatment.

## Abstract

Aortic arch aneurysms are often asymptomatic, being diagnosed incidentally in tests such as computed tomography, magnetic resonance imaging, or echocardiogram. Conventional treatment involves thoracotomy surgery, although treatment can also be performed using endovascular techniques. This article presents a case report of a complex aneurysm of the aortic arch with involvement of the left subclavian artery. Treatment was initiated with debranching of the supra-aortic trunks by carotid-carotid and carotid-subclavian bypasses, followed by ligation of the common carotid and left subclavian arteries. A second procedure was then needed to construct a surgical vascular conduit using a Dacron graft to obtain access to the aortic arch for the stent graft delivery device, due to the narrow caliber of the external femoral and iliac arteries. This report illustrates a satisfactory outcome in a case of aortic arch aneurysm with complex anatomy.

O aneurisma do arco aórtico é geralmente assintomático, sendo diagnosticado incidentalmente através de exames como tomografia computadorizada, ressonância magnética ou ecocardiograma. O tratamento convencional envolve cirurgia por toracotomia, também podendo ser realizado o tratamento através da técnica endovascular. O artigo apresenta um relato de caso de um aneurisma complexo do arco aórtico com comprometimento da artéria subclávia esquerda. O tratamento foi iniciado através de uma derivação dos troncos supra-aórticos, carotídeo-carotídea e carotídeo-subclávia, seguida da ligadura das artérias carótida comum e subclávia esquerda. Em um segundo momento, foi necessária a confecção de um conduíte vascular cirúrgico com prótese de Dacron para acesso ao dispositivo de entrega da endoprótese no arco aórtico, devido ao calibre reduzido das artérias femorais e ilíacas externas. O caso destaca a evolução satisfatória de um caso de aneurisma do arco aórtico de anatomia complexa.