Endovascular stenting for type B dissection involving a right-sided aortic arch

Abstract

Endovascular stent-graft repair is emerging as the treatment of choice for complicated type B aortic dissection. In this report we describe a patient who presented with type B aortic dissection involving a right-sided aortic arch (RAA), a rare congenital vascular anomaly. The initial aggressive medical treatment proved unsuccessful due to false aneurysm expansion. Given the greater complexity of conventional surgical repair and the limited experience with this rare malformation, endovascular repair was preferred and successfully performed. We report the first case of endovascular repair of type B dissection involving RAA, confirming that endovascular treatment is technically feasible also when the dissection involves this unusual vascular malformation.

Endovascular repair of thoracic aortic dissection associated with right-sided aortic arch: report of four cases

“…As a result of the great stress during a cardiac cycle to the proximal descending thoracic aorta and of decreased vessel tissure density in dilated aneurysms, patients with Kommerell's diverticulum are predisposed to dissections. In former studies, most cases of aortic dissection with right-sided arch were treated open-surgically ( Table 1 ) [ 1 , 3 ] We found a series of type III aortic dissections arising in the Kommerell's diverticulum. In all of our cases, the dissected tissue extended from the distal aortic arch through the thoracoabdominal aorta, which may increase operative difficulty and in-hospital mortality.…”

“…Since Yamazaki and Okada [ 6 - 7 ] successively established a feasible endovascular stent implantation strategy, endovascular prosthesis has developed rapidly and is now considered as an appealing alternative method for a descending thoracic aortic aneurysm with RAA. Recently, Croccia and colleagues have described the first case of a type B dissection associated with RAA treated with an endovascular approach [ 3 ] . Major advantages, compared with a standard surgical technique, include the lower level of invasiveness and the avoidance of more complex repairs and of the need for circulatory arrest.…”

“…For complicated aortic dissection, conventional open surgical repair is considered a standard therapy [ 2 ] . However, in such cases, endovascular repair has emerged as the procedure of choice as it is associated with favorable short- and mid-term results [ 3 ] . In this study, we present our experience with the use of thoracic endovascular aortic repair (TEVAR) technique for treatment of DeBakey III dissection in 4 patients with RAA.…”

Staged Hybrid Repair for Acute Type B Aortic Dissection of Right-Sided Aortic Arch

“…Only around 10 surgical cases of acute aortic type B dissection of RAA have been reported [1][2][3] (Table 1). We report one case of hybrid repair using short frozen elephant trunk (FET) for acute type B aortic dissection involving RAA.…”

Endovascular Repair With the Chimney Technique for Stanford Type B Aortic Dissection Involving Right-Sided Arch With Mirror Image Branching

“…1 Most cases have been treated surgically 2 ; only one case of Stanford B type aortic dissection with right-sided aortic arch has undergone thoracic endovascular aortic repair (TEVAR) to our knowledge. 3 In this report, we describe two cases of Stanford type B dissection involving a RAA with mirror image branching treated with TEVAR and the chimney technique.…”