A case of innominate artery aneurysm in a pregnant woman treated by endovascular stent grafting

Abstract

Innominate artery aneurysms are rare, accounting for only 0.26% of all aneurysms. Although usually asymptomatic, they carry a significant risk of rupture, which can be fatal, making timely diagnosis and treatment essential. There is limited literature on the management of innominate artery aneurysms during pregnancy, and no established treatment guidelines exist. In this case, a 42-year-old multigravida woman was diagnosed with an innominate artery aneurysm four years prior to pregnancy. Genetic panel testing ruled out inherited connective tissue disorders, including Marfan syndrome. The aneurysm measured 24 × 36 mm and possessed a saccular configuration. At 23 weeks of gestation, due to the high risk of rupture, the patient underwent successful endovascular stent grafting without complications. Later, the patient developed preeclampsia and fetal growth restriction, necessitating an emergency cesarean section at 33 weeks. A female infant was delivered, and both mother and neonate were discharged without further complications. Open surgical intervention with cardiopulmonary bypass is the standard therapeutic approach for innominate artery aneurysms. However, maternal and fetal mortality rates associated with cardiopulmonary bypass during pregnancy are high. This case suggests that although innominate artery aneurysms during pregnancy are exceedingly rare, endovascular repair with stent grafting may be a viable treatment option to avoid the serious maternal and fetal risks associated with aneurysm rupture or open surgical repair.departmental bulletin pape