11 cm Haughton D left cervical aortic arch aneurysm

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Thoracic Surgery

Background:

• Aortic arch aneurysms are rare, with cervical variants posing unique diagnostic and surgical challenges.
• Left cervical aortic arch aneurysms (Haughton D type) are exceptionally uncommon, often presenting with mass effect due to their size and location.

Observation:

• A 56-year-old man experienced sudden loss of consciousness due to an 11 cm Haughton D type left cervical aortic arch aneurysm.
• The aneurysm caused significant compression and stretching of adjacent structures, including the left common carotid artery, pulmonary trunk, left pulmonary artery, vagus, recurrent laryngeal, and phrenic nerves.
• Severe tracheal deviation and lumen compromise were noted, contributing to the patient's critical presentation.

Findings:

• The aneurysm originated between the left common carotid and left subclavian arteries, involving considerable aortic arch tortuosity.
• Surgical intervention involved successful interposition graft replacement of the distal aortic arch.
• The procedure was performed under total circulatory arrest with selective unihemispherical cerebral perfusion.

Implications:

• This case highlights the importance of considering rare aortic pathologies in patients with unexplained neurological symptoms.
• Successful surgical management of large cervical aortic arch aneurysms is feasible with advanced techniques like circulatory arrest and cerebral perfusion.
• This successful outcome underscores the potential for definitive treatment of complex aortic arch aneurysms, improving patient prognosis.