Endovascular treatment of a giant arteria lusoria aneurysm in a young female with Marfan syndrome

Aneurysms of an aberrant right subclavian artery (ARSA) are rare but constitute a potentially lethal condition, especially with concomitant Marfan syndrome (MFS). A 27-year-old female with confirmed MFS presented with a relevant progression of a known aneurysm of an ARSA in MRI. The patient had undergone valve-sparing aortic root replacement (David procedure) 4 months prior. After interdisciplinary discussion, she underwent endovascular exclusion of the aneurysm using a combination of established vascular plugs and novel shape memory polymer embolization plugs to fill the large ARSA aneurysm volume. The shape memory polymer embolization plugs expand in the vessel to a porous scaffold, designed to support thrombus formation throughout its structure. The polymer is also radiolucent, which minimizes artefact and facilitates follow-up imaging. Development of a strategy for the treatment of ARSA aneurysms is challenging and different surgical, endovascular, and combined approaches have been published. Interdisciplinary discussion is crucial to minimize the overall risk and trauma. In our case of a young female and new mother, an endovascular approach was successfully and safely performed. The future need for surgery due to concomitant MFS is expected.