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

Abstract

BackgroundAn 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 presentationWe 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.ConclusionEven 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.

How to Treat Type B Aortic Dissections in the Presence of an Aberrant Right Subclavian Artery: A Systematic Review

“…The final review included eight relevant case series 4 5 6 7 8 9 10 11 and 24 single case reports 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 comprising a total of 85 patients ( Fig. 2 ).…”

Successful medical treatment of aortic intramural hematoma (Stanford type B) in a patient with aberrant right subclavian artery: A case report

“…In some rare cases, patients may present with compressive symptoms on the trachea and esophagus. They will usually have dysphagia of solid food [8] .…”

One-stage supraclavicular hybrid procedure for type B aortic dissection involving three rare anatomical anomalies: a case report and literature review

“…We reviewed previous cases with one or more anomalies (Table 1). 2,7–20 Nonami et al. 7 reported that a patient with ARSA and ILVA with aortic aneurysm successfully underwent aortic arch replacement with five branches, in 1998.…”

“…However, traditional TEVAR is unsuitable for all patients because of landing zone limitations. Other surgeons have reported aortic dissection or aneurysm with ARSA or ILVA occurring alone, treated with total endovascular repair, 9–12 hybrid procedure, 12–17 or open surgery. 18–20…”

“…Some cases of TBAD with ARSA or ILVA have been treated successfully with a supraclavicular hybrid operation. 12–17 Supraclavicular hybrid TEVAR has the advantages of less invasiveness, and better efficacy and cost compared with open surgery with total arch replacement and total endovascular treatment, such as with multiple fTEVAR or chTEVAR. Thus, we designed a hybrid TEVAR with concomitant double transposition of the LSA and ILVA to the LCCA and single artificial bypass of the ARSA to the RCCA through bilateral supraclavicular incisions.…”