Endovascular Repair of a Right-Sided Descending Thoracic Aortic Aneurysm With a Right-Sided Aortic Arch and Aberrant Left Subclavian Artery Joseph J.

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Endovascular Repair of a Right-Sided Descending Thoracic Aortic Aneurysm With a Right-Sided Aortic Arch and Aberrant Left Subclavian Artery Joseph J. Naoum, MD, Jennifer L. Parenti, RN, Scott A. LeMaire, MD, Joseph S. Coselli, MD The Annals of Thoracic Surgery Volume 85, Issue 3, Pages 1074-1076 (March 2008) DOI: 10.1016/j.athoracsur.2007.09.032 Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Drawings and (B, C, D) arteriograms of the patient’s right-sided aortic arch, right-sided descending thoracic aortic aneurysm, and aberrant left subclavian artery. (B) Right anterior oblique (RAO) projection showing the right and left common carotid arteries arising from a common trunk. The right vertebral artery is dominant. (C) An RAO projection showing a left subclavian artery arising from a Kommerell’s diverticulum, which is particularly evident in the inset (arrow). The left vertebral artery is small. (D) A left anterior oblique view demonstrates the landing zone target immediately distal to where the right subclavian artery originates from the aorta. (a = artery; L = left; R = right.) The Annals of Thoracic Surgery 2008 85, 1074-1076DOI: (10.1016/j.athoracsur.2007.09.032) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Arteriogram showing a patent left carotid to subclavian artery bypass. No flow is visible in the proximal left subclavian artery, confirming its proximal ligation. (L = left.) The Annals of Thoracic Surgery 2008 85, 1074-1076DOI: (10.1016/j.athoracsur.2007.09.032) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Illustration of the completed repair, including left carotid to subclavian bypass and endovascular exclusion of the aortic aneurysm. The Annals of Thoracic Surgery 2008 85, 1074-1076DOI: (10.1016/j.athoracsur.2007.09.032) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Intraoperative arteriogram obtained after the endovascular repair was completed. The Annals of Thoracic Surgery 2008 85, 1074-1076DOI: (10.1016/j.athoracsur.2007.09.032) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions