Combined Endovascular and Open Repair of innominate artery bifurcation pseudoaneurysm: A case report

Abstract Background Innominate artery aneurysms (IAAs) are rare. Without timely treatment, they may result in rupture, distal arterial embolization, or local compression, among which rupture is the most dangerous complication. Here, a case of innominate artery bifurcation pseudoaneurysm is reported. Case Presentation: The patient was a 45-year-old man who presented to the emergency department complaining of chest discomfort. Subsequent computed tomographic angiography (CTA) imaging indicated the presence of a 3.6*2.4 cm saccular aneurysm in the bifurcation of the innominate artery, involving both the right proximal subclavian and common carotid arteries. His vital signs were normal, with equal blood pressures in the upper arms, and no neurological dysfunction. Gadolinium-enhanced magnetic resonance angiography indicated that the circle of Willis was intact. The operation was performed by open surgery combined with endovascular treatment. The external carotid artery was first transposed to the right subclavian artery (RSA) and an 8-mm woven Dacron graft was inserted in the middle. The covered stent graft was then placed in the proximal part of the innominate artery to close the entrance of the aneurysm. Lastly, the occluder was implanted into the origin of the RSA. There were no procedural or postprocedural complications. A year later, the aneurysm was not visible on CTA and the right vertebral artery was patent. Conclusions Combined Endovascular and Open Repair is an effective option for the treatment of innominate artery bifurcation pseudoaneurysm.