Abstract
Surgical treatment of intrathoracic subclavian artery (SCA) aneurysm often requiresis median sternotomy approach and it is challenging especially in patients after cardiac surgery. Here, we presented a successful surgical case underwent hybrid treatment which consisted of t endovascular therapy and crossover axillary bypass. A 77-years-old man was referred to our institution for the treatment of SCA aneurysm. He previously underwent coronary artery bypass graft via median sternotomy approach. Preoperative computed tomography revealed a 32 mm sized SCA aneurysm. An aneurysm was located at the proximal portion of the right SCA and extended to the bifurcation of brachiocephalic artery (BCA). Coronary angiography also showed patent internal mammary artery (IMA). Therefore, we employed hybrid approach in order not to injure the IMA by resternotomy procedure. After construction of axillo-axillar crossover bypass, covered stent graft was inserted from BCA to right common carotid artery and coil embolized into aneurysm. Postoperative course was uneventful and postoperative examination confirmed complete exclusion of the aneurysm and patency of the extra-anatomical bypass graft. Hybrid approach not necessitating stenotomy should be considered as a less invasive alternative to conventional surgical procedure in this particular circumstance.
