IA, right common carotid artery (CCA), and right subclavian artery appear straight, away from the origin of the left CCA with no direct compression over the trachea. … Discussion The case describes an uncommon entity that was reported only once in the literature, to the best of our knowledge.1 Diseases involving IA and requiring surgical repair are relatively uncommon and consequently

are rarely encountered. Tracheal compression caused by IA pathology was published in a few reports. De Feiter et al. described an IA AZD4547 aneurysm compressing the trachea after thoracic aortic aneurysm repair in a patient Inhibitors,research,lifescience,medical with Marfan disease.2 Montgomery et al. also reported tracheal compression by an IA aneurysm, but they declined to perform surgical repair as the mild symptoms did not justify the operative risk.3 Constenla et al. and Choi et al. both reported cases of IA aneurysm with airway compression

in patients with bovine aortic arch.4, 5 Brewster et al. published their experience with IA lesions. Among their 71 patients, 6 underwent operation Inhibitors,research,lifescience,medical for relief of tracheal compression. In five pediatric patients, this was attributed to presumed anomalous origin of IA more distally on the aortic arch. The remaining elderly patient in this group had tracheomalacia and respiratory insufficiency caused by prolonged pressure from an elongated and tortuous atherosclerotic IA similar to Inhibitors,research,lifescience,medical our patient.1 The method of revascularization varied in the different reports. The five pediatric patients in Inhibitors,research,lifescience,medical the Brewster et al. study underwent a pexy operation anteriorly to the sternum with relief of respiratory symptoms. The single elderly adult patient in this group required prolonged respiratory support for tracheomalacia.1 Choi et al. resected the segment of IA with pseudoaneurysm and reconstructed with an 8-mm Dacron graft.5 Constenla et al. placed a bypass from the ascending aorta (side-to-end anastomosis) to both common carotid arteries (end-to-end anastomoses) using a handmade

bifurcated Dacron graft.4 None of the reported methods of relief of the airway compression was found suitable in our Inhibitors,research,lifescience,medical case. Fixation of IA to the sternum was not acceptable new in view of the marked tortuosity and dilatation that would result in severe kinks. Excision of the elongated ectatic IA and reimplantation and/or replacement by a graft at the same site would have led to persistence constriction of the trachea, particularly with persistent of the adjacent left CCA origin (bovine trunk). Excising the redundancy in the CCA or subclavian arteries without changing the site of the IA origin would have led to marked angulation of either of them, causing possible symptoms later on. The only way to obtain an anatomic alignment and correct the tortuosity, remove the dilated IA segment, and eliminate the constricting effect of the bovine trunk was to disconnect the IA from its origin just distal to the CCA origin, excise the dilated segment, and reimplant proximally at the ascending aorta (Figure 4).