Total arch replacement for aortic arch aneurysm with coexisting middle aortic syndrome

Area of Science:

• Cardiovascular Surgery
• Vascular Medicine
• Surgical Innovation

Background:

• Middle aortic syndrome (MAS) combined with thoracic aortic aneurysm (TAA) presents a rare and complex clinical challenge.
• Surgical management of concomitant MAS and TAA requires innovative approaches to address extensive aortic disease.

Purpose of the Study:

• To describe a successful one-stage open surgical strategy for a patient with combined MAS and TAA.
• To highlight the efficacy of total arch replacement with a femorofemoral bypass in managing complex aortic pathology.

Main Methods:

• A 69-year-old male patient with a saccular aortic arch aneurysm, shaggy aorta, thoracoabdominal aorta stenosis (MAS), aberrant right subclavian artery, renovascular hypertension, renal dysfunction, and intermittent claudication underwent surgical repair.
• The procedure involved total aortic arch replacement using cardiopulmonary bypass with right axillary artery inflow and a femorofemoral crossover bypass. An additional extra-anatomical bypass from the ascending aortic graft to the femorofemoral bypass was established prior to weaning from bypass.

Main Results:

• Postoperative 3D-CT confirmed the patency of the bypass graft without stenosis.
• The patient experienced an uneventful recovery and was discharged with significant improvements in intermittent claudication, hypertension, and renal function.

Conclusions:

• One-stage open surgery, including graft bypass, can be performed successfully for MAS combined with TAA, mitigating intraoperative and postoperative complications.
• Combined total arch replacement and ascending aorta-to-bifemoral bypass is a viable alternative for treating complex MAS and TAA.