Case Presentation of Surgery for Double Aortic Arch Associated With Subclavian Artery Aneurysm

Double aortic arch is the most common complete vascular ring, frequently causing compression on the trachea and esophagus, and presenting with stridor, recurrent chest infection, or dysphagia lusoria (1). In 70% of cases the right arch is dominant but both arches together form a complete vascular ring (2). This case is a 37-year-old female presenting with dysphagia. 

CT chest with contrast revealed a double aortic arch associated with a huge subclavian artery aneurysm. Through a left posterolateral thoracotomy the 3rd interspace was entered, exposing the smaller left sided aortic arch and its branches. Proximal and distal control of the intrathoracic aneurysm was achieved. The non-dominant left sided arch was detached from the descending thoracic aorta and both ends were sutured using 4/0 Prolene sutures to disrupt the ring and release any compression on the trachea and esophagus. The ligamentum arteriosum was also ligated. After clamping the subclavian artery at its origin from the left sided arch and distal to the aneurysm at the thoracic inlet, the aneurysm was opened. Control of any branches arising from the aneurysm was achieved from within the sac using 4/0 Prolene sutures. An 8mm Dacron tube graft was anastomosed to the subclavian artery distal to the aneurysm and then attached proximally to the smaller left sided arch using 5/0 Prolene continuous sutures. Clamps were released followed by meticulous hemostasis and chest closure over 2 pleural drains.

The patient had a smooth postoperative course and was discharged home in excellent condition.

References

1. Longo-Santos LR, Maksoud-Filho JG, Tannuri U, Andrade WC, Gonçalves ME, Cardoso SR, et al.
2. Vascular rings in childhood: diagnosis and treatment. J Pediatr (Rio J) 2002;78:244-50.
3. Backer CL. Pediatric Cardiac Surgery. Liu JF, trans. 4th ed. Beijing:Peking University Medical Press, 2014:270.

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