A new inclusion technique through an upper partial sternotomy for complicated Stanford B-type aortic dissection with an aberrant right subclavian artery

Abstract OBJECTIVES Aortic dissection (AoD) in the presence of an aberrant right subclavian artery (ARSA) is very rare. Clinical experience is limited, and there is no consensus regarding the optimal management strategy. We seek to evaluate the safety and efficacy of the total arch replacement (TAR) and frozen elephant trunk (FET) technique as an approach to AoD in patients with ARSA by retrospectively analysing our single-centre experience. METHODS From 2009 to 2017, we performed TAR + FET for 22 patients with ARSA sustaining AoD (13 acute, 59.1%). The mean age was 46.0 years [standard deviation (SD) 8.3], and 19 patients were male (86.4%). ARSA orifice was dilated in 15 (68.2%) patients, and a Kommerall diverticulum was diagnosed in 13 (59.1%) patients with a mean diameter of 21.8 mm (SD 7.7; range 15–40). Surgery was performed via femoral and right/left carotid cannulation under hypothermic circulatory arrest at 25°C. The ARSA was reconstructed using a separate branched graft. RESULTS ARSA was closed proximally by ligation in 16 (72.7%) patients, direct suture in 4 (18.2%) patients and both in 2 (9.1%) patients. Operative mortality was 13.6% (3/22). Type Ib endoleak occurred in 1 (4.5%) patient at 8 days. Follow-up was complete in 100% at mean 4.2 years (SD 2.0), during which 3 late deaths and 1 reintervention for type II endoleak occurred. Survival was 81.8% and 76.4% at 3 and 5 years, respectively. Freedom from reoperation was 89.2% up to 8 years. In competing risks analysis, the incidence was 22.1% for death, 10.8% for reoperation and 67.1% for event-free survival at 5 years. The false lumen, ARSA orifice and Kommerall diverticulum were obliterated in 100%. Grafts were patent in 100%. No patients experienced cerebral ischaemia and upper extremity claudication. Hypothermic circulatory arrest time (min) was sole predictor for death and aortic reintervention (hazard ratio 1.168, 95% confidence interval 1.011–1.348; P = 0.034). CONCLUSIONS The TAR and FET technique is a safe and efficacious approach to AoD in patients with ARSA. Modifications of routine TAR + FET techniques are essential to successful repair, including femoral and right/left carotid artery cannulation, ligation of ARSA on the right side of the trachea and ARSA reconstruction with a separate graft.

Download Full-text

Aberrant Right Subclavian Artery and Stanford Type B Aortic Dissection

American Journal of Medical Case Reports ◽

10.12691/ajmcr-8-8-9 ◽

2020 ◽

Vol 8 (8) ◽

pp. 247-249

Author(s):

Yuvraj Chowdhury ◽

Shakil A. Shaikh ◽

Ali Salman ◽

Jonathan D. Marmur ◽

Isabel. M. McFarlane

Keyword(s):

Aortic Dissection ◽

Subclavian Artery ◽

Aberrant Right Subclavian Artery ◽

Type B ◽

Type B Aortic Dissection ◽

Stanford Type B

Download Full-text

Repair of a type B aortic dissection with a re-vascularization of the aberrant right subclavian artery in an adult patient

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-019-1031-7 ◽

2019 ◽

Vol 14 (1) ◽

Author(s):

Mahmoud Yousef Ibrahim Abuharb ◽

Bian Xiao Ming ◽

He Jian

Keyword(s):

Aortic Dissection ◽

Subclavian Artery ◽

Incidental Finding ◽

Aberrant Right Subclavian Artery ◽

Uneventful Recovery ◽

Type B ◽

Type B Aortic Dissection ◽

Case Presentation ◽

Therapeutic Implications ◽

Aortic Branch

Abstract Background An aberrant right subclavian artery which arises from the proximal descending aorta may result in aortic dissection. The dissection may occur at either the site of the primary intimal tear or from an aortic branch. These conditions may lead to blood flow limitation and possible aneurysmal degeneration in the future. Case presentation We described the clinical presentation and management of a 54-year old patient diagnosed with a rare case of an aberrant right subclavian artery with Stanford Type B aortic dissection. A hybrid surgical approach was successfully performed and the patient had an uneventful recovery. Conclusion Even though aortic dissection is often an incidental finding, this case highlighted that in rare situations, it can be associated with an aberrant right subclavian artery. It is important to disseminate this association as it has profound diagnostic and therapeutic implications in safeguarding the clinical outcomes of patients with such condition.

Download Full-text

Treatment with Aortic Stent Graft Placement for Stanford B-Type Aortic Dissection in a Patient with an Aberrant Right Subclavian Artery

Case Reports in Vascular Medicine ◽

10.1155/2015/746354 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5

Author(s):

Yohei Kawatani ◽

Yujiro Hayashi ◽

Yujiro Ito ◽

Hirotsugu Kurobe ◽

Yoshitsugu Nakamura ◽

...

Keyword(s):

Aortic Dissection ◽

Stent Graft ◽

Subclavian Artery ◽

Distal Portion ◽

Aberrant Right Subclavian Artery ◽

Type B ◽

Type B Aortic Dissection ◽

Aortic Stent Graft ◽

The Right ◽

Stanford Type B

A 71-year-old man visited our hospital with the chief complaint of back pain and was diagnosed with acute aortic dissection (Debakey type III, Stanford type B). He was found to have a variant branching pattern in which the right subclavian artery was the fourth branch of the aorta. We performed conservative management for uncomplicated Stanford type B aortic dissection, and the patient was discharged. An ulcer-like projection (ULP) was discovered during outpatient follow-up. Complicated type B aortic dissection was suspected, and we performed thoracic endovascular aortic repair (TEVAR). The aim of operative treatment was ULP closure; thus we placed two stent grafts in the descending aorta from the distal portion of the right subclavian artery. The patient was released without complications on postoperative day 5. Deliberate sizing and examination of placement location were necessary when placing the stent graft, but operative techniques allowed the procedure to be safely completed.

Download Full-text

Midterm Outcomes of Endovascular Repair for Stanford Type B Aortic Dissection with Aberrant Right Subclavian Artery

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2019.02.001 ◽

2019 ◽

Vol 30 (9) ◽

pp. 1378-1385

Author(s):

Weichang Zhang ◽

Xin Li ◽

Wenwu Cai ◽

Ming Li ◽

Jian Qiu ◽

...

Keyword(s):

Aortic Dissection ◽

Subclavian Artery ◽

Endovascular Repair ◽

Aberrant Right Subclavian Artery ◽

Type B ◽

Type B Aortic Dissection ◽

Stanford Type B

Download Full-text

Open Repair of Thoracoabdominal Aortic Aneurysm in a 46-Year-Old Man with Pleural Adhesions and Aberrant Right Subclavian Artery

Texas Heart Institute Journal ◽

10.14503/thij-17-6274 ◽

2018 ◽

Vol 45 (3) ◽

pp. 179-181

Author(s):

Jae Hyun Kim ◽

Kyung Sub Song ◽

Jae Bum Kim

Keyword(s):

Aortic Aneurysm ◽

Aortic Dissection ◽

Subclavian Artery ◽

Open Surgery ◽

Open Repair ◽

Thoracoabdominal Aortic Aneurysm ◽

Aortic Aneurysms ◽

Aberrant Right Subclavian Artery ◽

Multiple Abnormalities ◽

Complex Cases

Endovascular aortic treatment is being performed more often and offers some advantages over open surgery. Nevertheless, open repair of thoracoabdominal aortic aneurysms is still relevant in complex cases, including combined chronic aortic dissection, congenital aortic abnormalities such as aberrant right subclavian artery, and dense pleural adhesions after a previous thoracotomy. We describe our successful use of open repair in a 46-year-old man who had these multiple abnormalities.

Download Full-text

Aberrant Right Subclavian Artery Mimics Aortic Dissection

Circulation ◽

10.1161/01.cir.101.4.459 ◽

2000 ◽

Vol 101 (4) ◽

pp. 459-460 ◽

Cited By ~ 1

Author(s):

Maarten Janssen ◽

Christian S. Breburda ◽

Robert Jan M. van Geuns ◽

Walter R. M. Hermans ◽

Peter Klootwijk ◽

...

Keyword(s):

Aortic Dissection ◽

Subclavian Artery ◽

Aberrant Right Subclavian Artery

Download Full-text

Endovascular Aortic Repair With Castor Single-Branched Stent-Graft in Treatment of Acute Type B Aortic Syndrome and Aberrant Right Subclavian Artery

Vascular and Endovascular Surgery ◽

10.1177/15385744211005664 ◽

2021 ◽

pp. 153857442110056

Author(s):

Xinyan Pang ◽

Shi Qiu ◽

Chen Wang ◽

Kai Liu ◽

Xin Zhao ◽

...

Keyword(s):

Aortic Dissection ◽

Stent Graft ◽

Subclavian Artery ◽

False Lumen ◽

Endovascular Aortic Repair ◽

Aberrant Right Subclavian Artery ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection ◽

Aortic Repair

Objective: In this retrospective study, we presented the results of Castor single-branched stent-graft in a small series of patients with acute type B aortic syndrome and aberrant right subclavian artery (ARSA). Methods: Between January 2019 and November 2019, 5 patients were diagnosed with acute type B aortic syndrome and ARSA (4 patients with intramural hematoma and ARSA, 1 patient with type B aortic dissection and ARSA). All the patients underwent thoracic endovascular aortic repair (TEVAR) using Castor single-branched stent-graft. In-hospital and 3-month outcomes were collected. Results: The mean operative time was 116 ± 20.43 minutes (range 90-145). All the TEVAR procedures were successfully performed without conversion to open surgery (100% success rate). All the ARSAs of the 5 patients were revascularized in situ by Castor single-branched stent-grafts. No deaths and complications were observed in the 3-month follow-up. The maximal diameters of diseased aortas in the 4 patients with IMH decreased 3 months after TEVAR. The false lumen in the graft-covered segment was completely thrombosed in the patient with type B aortic dissection. Conclusions: Castor single-branched stent-graft may be a good choice in treatment of acute type B aortic syndrome and aberrant right subclavian artery.

Download Full-text