A Clinical Case of Aneurysmal Dilatation of the Aortic Arch Distal to the Origin of an Aberrant Right Subclavian Artery Treated with Castor Single-Branch Stent Graft Implantation and Right Carotid-Subclavian Bypass

TL;DR

A 78-year-old patient with a complex aortic aneurysm near an abnormal artery was successfully treated using a specialized stent graft and a bypass procedure.

Contribution

Demonstrates the feasibility of using a Castor single-branch stent graft in treating distal aortic arch aneurysms with vascular anomalies.

Findings

A hybrid procedure combining a carotid-to-subclavian bypass and stent graft implantation successfully treated a complex aortic arch aneurysm.

Plug embolization of the ARSA origin prevented a type II endoleak following stent graft deployment.

Abstract

Advancements in endovascular stent graft design have enabled the treatment of distal aortic arch pathologies. However, the length of the proximal landing zone remains a limitation, especially with vascular anomalies like an aberrant right subclavian artery (ARSA) posing additional challenges. A 78-year-old patient underwent computed tomography angiography (CTA), which revealed progressive enlargement of a distal aortic arch aneurysm located beyond an ARSA that coursed between the esophagus and trachea. Following evaluation by the multidisciplinary Aortic Team, a hybrid procedure was planned. A right carotid-to-ARSA bypass was performed and a Castor single-branched stent graft (CSBSG) was deployed in the aortic arch with its side branch directed into the left subclavian artery (LSA), thereby covering the origin of the ARSA. To prevent a type II endoleak, plug embolization of the ARSA origin was subsequently performed. CSBSG is a feasible treatment for distal aortic arch aneurysms, even in the presence of vascular anomalies such as ARSA.

Figures