Surgical case of anomalous systemic arterial supply to basal segment with its root dissected and sutured

Abstract

A 67-year-old woman with cough and fever visited a nearby clinic. Chest contrast-enhanced computed tomography (CT) revealed an aberrant artery with a diameter of 20 mm arising from the descending aorta and entering the left basal segment. She was diagnosed with anomalous systemic arterial supply to the basal segment and referred to our institution for surgical intervention. Surgery was performed through two access windows (5th and 7th intercostal spaces) and two ports (7th and 8th intercostal spaces). Suture of the aortic wall was performed under both direct and thoracoscopic views, while other intrathoracic procedures were performed only under a thoracoscopic view. The diameter of the aberrant artery was large, as can be noted on the preoperative CT, and we were concerned about an aneurysm at the site of the vascular cut end; therefore, the aberrant artery was dissected and sutured at the descending aorta wall after side-clamping at the origin of the aberrant artery. After the aberrant artery was dissected, blood flow from the pulmonary artery to left lower lobe was confirmed using the indocyanine green fluorescence method. Thus, a decrease in the blood flow to the entire left lower lobe was confirmed, and the left lower lobe was resected. Postoperative pathological examination revealed a thin tunica media and thick tunica intima of the aberrant artery. Disrupted elastic fibers and myxoid change were also observed in the tunica media. Her postoperative course was uneventful, and no abnormality was observed in the aortic wall at 19 months postoperatively. Our case suggested the possibility of tissue fragility of the vessel wall if the diameter of the aberrant artery was large. The method of treating the aberrant artery should be considered carefully for each case.