Abstract
A 65-year-old man complaining of severe dyspnea was transferred to our hospital because computed tomography (CT) revealed his trachea to be almost completely collapsed by a large right common carotid artery aneurysm. As we assumed that the aneurysm was at risk of imminent rupture an emergency operation was conducted by a full sternotomy using cardiopulmonary bypass through both the femoral vein and artery. The carotid artery aneurysm originated from the orifice at the junction of brachiocephalic artery and totally occluded the distal bifurcation. The orifice was closed by direct sutures. Tracheal compression was relieved and the patient was discharged on the 21st postoperative day for referral for rehabilitation. However, 43 days after the initial operation, he presented with sudden syncope and dyspnea. Emergency CT revealed a recurrent carotid aneurysm which developed from the leakage of the orifice. Cancer nodules were also observed in both lungs. He was transferred to our hospital and intubated on the 7th day after readmission because of his worsening dyspnea. As multiple brain metastases of the lung cancer were suspected in the right cerebrum, we performed an endovascular repair with a custom made stent graft, which was successfully delivered via the right axillary artery to cover the right carotid artery orifice. He was weaned off the respirator and CT did not show any evidence of endoleak of the graft. However, consciousness impairment was sustained due to a new onset of left cerebral infarction. Tracheostomy was performed and the patient was discharged to a referral hospital on the 42nd day after endovascular repair.
