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Abstract
Aberrant right subclavian artery (ARSA) is a rare anatomic variant in which the right subclavian artery originates distal to the left subclavian artery (LSA) and crosses the midline in a retroesophageal course before assuming its right subclavicular position. Patients with acute type B aortic dissection (ATBAD) and ARSA pose a unique challenge due to the absence of an appropriate proximal landing zone for thoracic endovascular aortic repair (TEVAR) without covering both subclavian arteries. In this case series, 2 different hybrid techniques of central 4-vessel arch reconstruction with TEVAR are described to treat 4 patients with complicated ATBAD and ARSA.
Highlights
On surveillance imaging 4 years after her index procedure, she had developed a 6.0-cm extent IV thoracoabdominal aortic aneurysm. She subsequently underwent an open repair using left heart bypass, with aortic replacement from the distal descending to the bilateral common iliac arteries (Figure 1)
The use of extra-anatomic cervical bypasses carries a risk of stroke, thoracic duct injury, recurrent laryngeal (5%) and axillary nerve injury (2%), and a reported 25% risk of phrenic nerve injury.[1]
The primary intimal tear (PIT) in 2 patients originated at the ostium of the left subclavian artery (LSA), and the PIT in the third patient originated in a 5.5-cm Kommerell diverticulum
Summary
MD,a Atlanta, Ga. From the Divisions of aCardiothoracic Surgery and bVascular and Endovascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga. Disclosures: The authors reported no conflicts of interest. The editors and reviewers of this article have no conflicts of interest. MD, Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, 1365-A Clifton Rd NE, Suite A 2213, Atlanta, GA 30322 (E-mail: bleshno@emory.edu). Aortic arch reconstruction with multibranch graft and anastomoses to supra-aortic vessels
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