A Case of Staged Hybrid Repair for Subacute Type B Aortic Dissection in a Patient with Shaggy Aorta

Purpose: The management of patients with chronic Stanford type B aortic dissection who develop complications requires intervention without clear guidelines. Chronic aortic dissection is difficult to treat and often leads to significant morbidity and mortality. We report a complex case of chronic Stanford type B aortic dissection (TBAD) with an expanding false lumen aneurysm and distal fenestrations that required a multi-stage hybrid repair. Technique: The patient first underwent a median sternotomy for the ascending aorta to the innominate artery and innominate artery to the left carotid artery bypass, followed by a left carotid to left axillary artery bypass. Due to continued aneurysmal growth, the patient ultimately underwent total cervical and abdominal aortic debranching as well as thoracic and abdominal endovascular grafting with iliac excluders. The patient recovered well after the surgery and had no further expansion of the aneurysm at 12-month follow up. Conclusion: Endovascular repairs have been the mainstay of chronic TBAD repair, but hybrid approaches may be necessary for difficult repairs. A multi-stage hybrid repair approach has been successful in a patient who had a chronic type B aortic dissection with aneurysmal degeneration that failed medical management.

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Staged Hybrid Repair of Thoracoabdominal Aortic Aneurysm after Chronic Type B Aortic Dissection

Vascular ◽

10.2310/6670.2010.00061 ◽

2010 ◽

Vol 18 (6) ◽

pp. 336-343 ◽

Cited By ~ 5

Author(s):

N. Mangialardi ◽

P. Costa ◽

P. Bergeron ◽

E. Serrao ◽

S. Ronchey

Keyword(s):

Aortic Aneurysm ◽

Aortic Dissection ◽

Thoracoabdominal Aortic Aneurysm ◽

Type B ◽

Type B Aortic Dissection ◽

Chronic Type ◽

Hybrid Repair

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Hybrid Repair of Ruptured Type B Aortic Dissection Extending into an Aberrant Right Subclavian Artery in a Patient With Turner's Syndrome

Annals of Vascular Surgery ◽

10.1016/j.avsg.2013.04.007 ◽

2013 ◽

Vol 27 (8) ◽

pp. 1182.e1-1182.e4 ◽

Cited By ~ 4

Author(s):

Alireza Hamidian-Jahromi ◽

Jonathan D. Carroll ◽

Linda D. Doucet ◽

Wayne W. Zhang

Keyword(s):

Aortic Dissection ◽

Subclavian Artery ◽

Aberrant Right Subclavian Artery ◽

Turner's Syndrome ◽

Type B ◽

Turner’S Syndrome ◽

Type B Aortic Dissection ◽

Hybrid Repair

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

Journal of Endovascular Therapy ◽

10.1177/1526602821996717 ◽

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.

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