Hybrid treatment of a giant thoracic aortic aneurysm after surgical correction of aortic coarctation

A case report is presented of a successful hybrid treatment using combined open and endovascular techniques in a patient who developed a giant saccular aortic arch aneurysm during the late period following surgical correction of aortic coarctation in childhood. The young male patient complained of a heavy sensation in the left chest. Multislice CT (MSCT) revealed a large saccular aneurysm of the aortic arch, with a maximum diameter of 9 x 9 cm, extending to the origin of the left subclavian artery. Elective treatment included left carotid–subclavian bypass using a synthetic graft, simultaneous implantation of a stent graft in the Z1 zone of the aortic arch, intraoperative fenestration of the endograft at the left common carotid artery ostium, and subsequent stenting of the carotid origin. Intraoperative fluoroscopy with CT navigation achieved optimal outcomes: adequate perfusion through all brachiocephalic vessels, absence of endoleaks, and reduced contrast exposure. The postoperative course was uneventful, with the patient mobilized on day one and discharged in stable condition on day seven. Twelve-month follow-up MSCT demonstrated complete aneurysm thrombosis and stable stentgraft patency. This case illustrates that hybrid minimally invasive approaches complemented by CT-guided navigation may significantly enhance the safety and efficacy of treating complex aortic arch aneurysms in patients with prior vascular corrections.