11 cm Haughton D left cervical aortic arch aneurysm

A 56 year old Caucasian man presented with sudden loss of consciousness while driving and was found to have an 11 cm Haughton D type left cervical aortic arch aneurysm with normal brachiocephalic branching and normal descending thoracic laterality but with considerable tortuosity and redundancy of aortic arch. The aneurysm arose between the left common carotid artery and the left subclavian artery. It compressed and stretched the left common carotid artery, compressed the pulmonary trunk and the left pulmonary artery, stretched the vagus, left recurrent laryngeal and left phrenic nerves and caused extreme deviation of trachea, severely compromising the tracheal lumen. Patient underwent successful interposition graft replacement of distal aortic arch under total circulatory arrest and selective unihemispherical cerebral perfusion.