Endovascular repair of an intrathoracic subclavian artery aneurysm with a single-branched thoracic endograft in a hostile anatomy

Objective Subclavian artery aneurysms (SAA) are rare and usually involve the proximal segment of the artery. In this setting traditional surgical treatment or hybrid procedures are associated with significative morbidity rate so that new endovascular solutions are preferred. Methods Authors report a case of a patient with an intrathoracic left SAA involving the aortic arch’s outer curve. Patient’s comorbidities contraindicated open surgical treatment while anatomical issues were not favourable to hybrid or standard endovascular solutions. Thus a single-branched custom-made thoracic stent-graft (Castor, MicroPort Medical, Shanghai, China) was implanted. Results Technical success was achieved with no intra-operative complications and technical steps of the procedure are accurately described. A pre-discharge CT scan showed the correct position of the endograft, complete aneurysm exclusion and branch patency. Conclusion Single-branched thoracic stentgrafts could be a good option in unfavourable anatomies with supra-aortic vessels disease involving the aortic arch, with good results in terms of morbidity and early outcomes.