scholarly journals Three Rare Structural Anomalies: Right Aberrant Subclavian Artery, Kommerell’s Diverticulum, and Isolated Left Vertebral Artery All Associated with Type B Aortic Dissection

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Yasser Farag Elghoneimy ◽  
Medhat Reda Nashy ◽  
Ahmed Elsayed Mahmoud ◽  
Asayel Ali Alruwaili ◽  
Assayl Rabea Alotaibi
Keyword(s):  
Aortic Dissection ◽  
Vertebral Artery ◽  
Subclavian Artery ◽  
Left Vertebral Artery ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Aberrant Subclavian Artery ◽  
First Case ◽  
Kommerell’S Diverticulum ◽  
Structural Anomalies

Introduction and Background. Right aberrant subclavian artery accounts for 0.5-1.8% of the population as the most frequently encountered aortic arch anomaly, while the prevalence of an isolated left vertebral artery ranges from 3 to 8%. Despite the low prevalence and the asymptomatic presentation of these structural anomalies, the development of cardiovascular complications and aneurysmal formation could happen as in Kommerell’s diverticulum in a complicated right aberrant subclavian artery, which can undergo aneurysmal degeneration and dissection. Depending on the severity and the degree of the symptoms, the management of the patient can be determined. Case Presentation. A 51-year-old male hypertensive Pakistani patient was admitted complaining of chest and back pain; a CT of the aorta was done and showed type B aortic dissection associated with a right aberrant subclavian artery with an isolated left vertebral artery. A thoracic endovascular aneurysmal repair was done, and the patient improved afterward. Conclusion. The prevalence of these structural anomalies, the right aberrant subclavian artery, Kommerell’s diverticulum, and isolated left vertebral artery with type B aortic dissection, is uncommon. Therefore, the earlier the diagnosis, the better the treatment. This is the first case report explaining the occurrence of these vascular anomalies together in Saudi Arabia.

scholarly journals Custom-made endograft with left subclavian artery branch in a patient with Takayasu aortitis complicated by type-B dissection and inflammatory involvement of the epiaortic vessels

2020 ◽  
Author(s):  
Antonio Rizza ◽  
Alberto R De Caterina ◽  
Cataldo Palmieri ◽  
Sergio Berti
Keyword(s):  
Aortic Dissection ◽  
Vertebral Artery ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Left Vertebral Artery ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Custom Made ◽  
Type B Dissection ◽  
Artery Branch

Abstract Type-B aortic dissection in a patient affected by Takayasu disease is a rarely described condition and its management can be challenging. A 47-year-old woman with Takayasu aortitis and previous aortic valve and ascending aorta replacement was admitted to hospital for type-B aortic dissection. The recent instabilization of aortic disease, the persistence of episodes of transient chest pain and the largest size of the aneurismatic tract of thoracic descending aorta rendered an invasive approach mandatory. Since the patient presented a complete bilateral occlusion of the subclavian artery just after the origin of the vertebral artery and a subcritical, smooth, bilateral stenosis of the common carotid artery, a custom-made endograft with left subclavian artery branch was successfully positioned, thus allowing the preservation of antegrade left vertebral circulation. This is the first case reporting an entirely endovascular exclusion of type-B dissection in a patient affected by Takayasu aortitis using a custom-made endograft with a subclavian branch allowing the preservation of the antegrade flow to left vertebral artery.

scholarly journals Type B aortic dissection repair using a Thoraflex hybrid prosthesis in a setting of aberrant left vertebral artery

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
Saifullah Mohamed ◽  
Akshay J Patel ◽  
Yassir Iqbal ◽  
Khurum Mazhar ◽  
Uday Dandekar ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Vertebral Artery ◽  
Left Vertebral Artery ◽  
Type B ◽  
Frozen Elephant Trunk ◽  
Type B Aortic Dissection ◽  
Elephant Trunk ◽  
Aortic Replacement ◽  
Increased Risk ◽  
Hybrid Prosthesis

Abstract Type B aortic dissection (TBAD) is often managed conservatively with intervention reserved for complicated cases. Strategies for complicated and uncomplicated TBAD can involve optimal medical therapy, thoracic endovascular aortic replacement and open surgical repair of TBAD with replacement of the affected segment of aorta and reimplantation of aortic branches. The frozen elephant trunk technique has been reported to be a successful surgical strategy in patients with complicated TBAD, particularly in patients who possess unfavourable aortic arch anatomy for endovascular stenting or at increased risk of retrograde Type A aortic dissection. The Thoraflex is a commercially available aortic graft, manufactured by Vascutek®. We describe a successful case of addressing complicated TBAD with rare variant aortic anatomy using a Thoraflex hybrid frozen elephant trunk graft and reimplantation of the aberrant left vertebral artery to the perfusion limb of the Thoraflex graft.

scholarly journals Management of type B aortic dissection with an isolated left vertebral artery

2019 ◽  
Vol 70 (4) ◽  
pp. 1065-1071 ◽  
Author(s):  
Huanyu Ding ◽  
Yi Zhu ◽  
Huiyong Wang ◽  
Songyuan Luo ◽  
Yuan Liu ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Vertebral Artery ◽  
Left Vertebral Artery ◽  
Type B ◽  
Type B Aortic Dissection

Hybrid Repair With Endovascular Debranching of the Aberrant Right Subclavian Artery for Complicated Type B Aortic Dissection in Patients With Kommerell’s Diverticulum

2021 ◽  
pp. 152660282199671
Author(s):  
Yu-Chen Chien ◽  
Nai-Kuan Chou ◽  
I-Hui Wu
Keyword(s):  
Aortic Dissection ◽  
Subclavian Artery ◽  
Bypass Graft ◽  
Covered Stent ◽  
Aberrant Right Subclavian Artery ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Landing Zone ◽  
Kommerell’S Diverticulum ◽  
Hybrid Repair

Purpose: Aberrant right subclavian artery (ARSA) associated with Kommerell’s diverticulum (KD) is a common congenital arch anomaly. It can be complicated by type B aortic dissection (TBAD) or aneurysmal formation at its ostium. Recently, hybrid repair with thoracic endovascular aortic repair (TEVAR) has appeared to be more favorable. Due to the normal anatomic proximity of the ARSA to the left subclavian artery (LSA) orifice in KD, coverage of the bilateral subclavian arteries (SCAs) to obtain an adequate proximal landing zone (PLZ) is usually required, and double cervicotomy for SCA revascularization potentially increases the risk of complications. Technique: This technique was demonstrated on a 50-year-old man presenting with progressive aneurysmal formation of KD with ARSA after chronic TBAD. A 3-step technique, namely left cervical debranching with a left common carotid artery to LSA bypass graft, TEVAR, and an LSA-to-ARSA endovascular debranching with a self-expanding covered stent by a through-and-through wire from the right brachial artery to the bypass graft, was performed in a 1-stage repair to cover the primary tear of TBAD and preserve the bilateral SCAs. The postoperative course was uneventful. Conclusion: This technique can prevent complications from double cervicotomy and achieve an adequate PLZ with preservation of the bilateral SCAs for TEVAR.

Complications after Endovascular Repair of Type B Aortic Dissection

2002 ◽  
Vol 9 (6) ◽  
pp. 822-828 ◽  
Author(s):  
Reinhard S. Pamler ◽  
Thomas Kotsis ◽  
Johannes Görich ◽  
Xaver Kapfer ◽  
Karl-Heinz Orend ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Stent Grafting ◽  
Stent Graft Implantation ◽  
Graft Implantation

Purpose: To outline the complications encountered after endoluminal treatment in patients with type B aortic dissection. Methods: Between 1999 and 2001, 14 patients (12 men; mean age 60.3 years, range 39–79) with isolated type B aortic dissection (13 chronic, 1 acute) underwent aortic stent-grafting. Three patients with chronic dissection presented an acute clinical picture and were managed emergently. The left subclavian artery was intentionally covered by the prosthesis in 9 patients. Follow-up studies were performed at 6-month intervals. Results: Stent-graft implantation was technically successful in all patients, but incomplete sealing (endoleak) of the entry site required additional proximal stent-graft implantation in 4. The left subclavian artery remained patent in 5 patients. Secondary conversion was required in 3 patients: 2 for acute type A dissection resulting from injury to the aortic arch by Talent endografts and a sustained hemorrhage (left hemothorax). In another patient, a secondary intramural hematoma subsided spontaneously. Anterior spinal artery syndrome in 1 patient persisted at 1 month. No bypass was necessary for the 9 patients with the covered left subclavian arteries. Mean follow-up was 14 months (range 1–23). Conclusions: Stent-grafting is feasible in patients with type B aortic dissection, although it is associated with a considerable rate of complications. Frank reporting of these sequelae for a variety of stent-grafts is of paramount importance to clarifying the limitations of the method.

scholarly journals Aberrant Right Subclavian Artery and Stanford Type B Aortic Dissection

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

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

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.

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

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.

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