Endovascular Treatment with Stent Graft for Left Intrathoracic Subclavian Artery Aneurysm Post Coronary Artery Bypass Grafting Using Left Internal Mammary Artery

Abstract

A 70-year-old man who had a history of coronary artery bypass grafting via median sternotomy admitted for the treatment of huge intrathoracic left subclavian artery (SCA) aneurysm. Preoperative computed tomography revealed a 52 mm sized SCA aneurysm. An aneurysm was located at the proximal portion of the left SCA. Coronary angiography showed the left circumflex artery perfused the patent left internal mammary artery (IMA). Open repair requiring re-sternotomy or thoracotomy may be too invasive. Therefore, we employed endovascular treatment to avoid the injury to the left IMA graft and the risk of myocardial ischemia during open revascularization of the left SCA. A reversed Zenith iliac leg whose third portion was stripped of the covering fabric, were placed in the left SCA for preserving the left IMA graft. Postoperative course was uneventful. The isolation of the aneurysm could be achieved without a myocardial and cerebellar ischemia. Endovascular treatment should be considered as a less invasive alternative to conventional surgical repair in this selected patient with the intrathoracic SCA aneurysm.