Endovascular treatment of a descending thoracic aorta aneurysm in a patient with right sided aortic arch: a case report.

Backround: Right-sided aortic arch is a rare congenital variant. The Edwards classification describes three types of right sided-aortic arch: right aortic arch with aberrant left subclavian artery, right aortic arch with mirror image branching, and right aortic arch with isolation of the left subclavian artery. Aneurysms associated with right sided aortic arch are rare. Pain is the commonest presenting symptom, but due to the anatomy of the right aortic arch, the symptoms may be atypical, as dysphagia. We present a case of a challenging endovascular repair in a patient with aneurysm of descending thoracic aorta and right aortic arch.

Case presentation: Α 55 year old patient was admitted in our hospital with chest pain. After the initial clinical and laboratory workout that was negative for acute coronary syndrome, Computed Tomography Angiography revealed an aneurysm of the descending aorta 10,3 cm in width, and a right sided aortic arch (Edwards' classification). Endovascular repair was selected as the treatment option of choice. Technically the endografting was challenging, firstly because of the right sided aortic arch, secondly because the four aortic branches originate independently. In order to identify the orifices of arch vessels during the angiography, brachial access in both upper extremities was achieved. In this way, it was possible to correctly deploy the thoracic aortic stent graft. No endoleaks were observed in the final angiography. Postoperative Computed Tomography Angiography 10 months after the operation showed no endoleaks.

Conclusion: This case indicates that TEVAR is feasible as a treatment option in patients with right-sided aortic arch, even though technically is challenging. However more evidence-based data are needed to certify long-term safety and efficacy of endovascular repair in treatment of thoracic aortic aneurysm associated with right-sided aortic arch.