Treatment of aberrant subclavian artery combined with aortic dissection and analysis of interim results

Abstract

Objective This retrospective study is to investigate the clinical features,treatment methods,and follow-up results of aberrant subclavian artery (ASA) combined with aortic dissection (AD). Methods Totally 17 patients with ASA combined with AD (ASA+AD) admitted to our hospital from August 2013 to February 2018,were included. Among these patients,there were 14 acute cases and 3 chronic cases; 13 males and 4 females; aged from 28 to 82 years,with the mean age of (54±14) years. All the ASAs in these 17 patients were located behind the esophagus. There were 15 cases of aberrant right subclavian artery (ARSA),including 13 cases of Stanford type B AD (TBAD) and 2 cases of Stanford type A AD (TAAD). The other 2 cases of aberrant left subclavian artery (ALSA) was combined with TBAD. In these 15 patients combined with TBAD,8 cases received the hybridization treatment,4 patients underwent the simple transluminal stent-graft placement,and 3 cases were subjected to the conservative treatment. All the other 2 patients combined with TAAD received the surgical treatment. Results Out of these 17 patients,16 cases were successfully followed up,while 1 patient was lost in the follow-up period (who received the conservative treatment). The follow-up period lasted from 5 to 58 months,with an average of (30±15) months. In the patients receiving the hybridization treatment,1 case reported perioperative death,and another 1 case suffered from severe endoleakage. In the patients receiving the simple transluminal stent-graft placement,1 case reported coldness in right upper extremity,combined with numbness. One case receiving the surgical treatment reported severe endoleakage within 3 months after operation. Moreover,2 cases reporting severe inner leakage underwent the secondary embolization treatment,obtaining satisfactory embolization effects. For the one case reporting coldness in right upper extremity,combined with numbness,after endovascular repairing treatment,the symptoms were significantly relived after drug treatment,without surgical treatment. No sever complications had been reported for the other patients during the follow-up period. Conclusion Patients with ASA+AD should be clearly diagnosed before surgery,and specific surgical plans should be determined according to specific conditions. Surgical treatment should be preferred for the patients of ASA combined with TAAD. For the patients of ASA combined with TBAD,the TEVAR or hybridization treatment or fenestration treatment could be considered,according to the condition of the arch branch vessels. Key words: Subclavian artery; Aorta; Aneurysm, dissecting; Radiology, interventional; Vascular surgical procedures