Two-stage elephant trunk reconstruction for aneurysm of an aberrant right subclavian artery in association with aneurysmal distal aortic arch and descending thoracic aorta

Surgical treatment of the combination of aneurysms of an aberrant right subclavian artery, distal aortic arch, and descending thoracic aorta requires control of structures in both the right and the left hemithorax. We report a 2-stage surgical approach. The 1st stage, performed through a median sternotomy, consists of an elephant trunk reconstruction and an interposition graft to the ligated aberrant right subclavian artery. The 2nd stage, performed through a left thoracotomy, is an interposition graft from the elephant trunk to the distal descending thoracic aorta.