A Complex Case of Ortner’s Syndrome with Emphasis on Peri-TEVAR Procedure Considerations for CVA Prevention

Introduction: Cardiovocal syndrome, or Ortner's syndrome, is a rare condition characterized by hoarseness due to left recurrent laryngeal nerve palsy, typically associated with cardiovascular abnormalities. Case Presentation: We present the case of a 62-year-old male with prolonged hoarseness. A workup revealed a fixed left true vocal cord, and a subsequent chest CT scan demonstrated a large aortic arch pseudoaneurysm, implicating compression of the left recurrent laryngeal nerve. The patient's complex cardiovascular profile included coronary disease and a diminutive right vertebral artery, necessitating a tailored approach to management. Discussion: Despite its benefits, thoracic endovascular aortic repair (TEVAR) carries significant risks, such as stroke and spinal cord ischemia. The decision-making process for revascularization, particularly of the left subclavian artery, remains nuanced and patient-specific, lacking a universal consensus. This case underscores the critical need for comprehensive pre-procedural evaluation, highlights the challenges in managing incidental findings during TEVAR, and emphasizes the importance of individualized patient care.