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Case Reports
. 2022 Mar 22;8(2):214-217.
doi: 10.1016/j.jvscit.2022.03.003. eCollection 2022 Jun.

Hybrid repair of acute type B dissection with aberrant right subclavian artery and bicarotid trunk

Peter S Downey  1 , Axel Thors  2 , Phillip Johnson  3 , Kamal Gupta  4 , William J Wallisch  5 , Omar Almoghrabi  1 , Gregory F Muehlebach  1 , George L Zorn 3rd  1
Affiliations
Case Reports

Hybrid repair of acute type B dissection with aberrant right subclavian artery and bicarotid trunk

Peter S Downey et al. J Vasc Surg Cases Innov Tech. .

Abstract

Patients with type B aortic dissection (TBAD) often present as an emergency. Operative repair of TBAD can be indicated for selected patients in the setting of hemodynamic instability or rupture. Thoracic endovascular aortic repair of TBAD has achieved significant popularity. Variant aortic arch anatomy can present a significant clinical challenge in patients with an inadequate proximal landing zone for thoracic endovascular aortic repair. A three-stage, hybrid aortic arch debranching and endovascular repair of a ruptured TBAD in a patient with a bicarotid trunk and an aberrant right subclavian artery was successfully performed using a unique technical approach.

Keywords: Aortic arch debranching; Aortic arch replacement; Aortic dissection; Hybrid aortic arch repair; Thoracic endovascular aortic repair.

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Figures

Fig 1
Fig 1
Preoperative computed tomography angiogram (CTA) demonstrating a 7.9-cm ruptured type B aortic dissection (TBAD). A, Axial configuration showing an intimal tear with contrast filling a large false lumen. B, Coronal configuration showing true lumen compression and increased soft tissue density in the mediastinum. C, Three-dimensional reconstruction showing variant arch branching anatomy, including a bicarotid arterial trunk, left subclavian artery, and an aberrant right subclavian artery.
Fig 2
Fig 2
A, Postoperative computed tomography angiogram (CTA) demonstrating a patent right carotid artery to right subclavian artery bypass graft with interruption of the native aberrant right subclavian artery (A), a patent common bicarotid trunk and left subclavian artery debranching graft (B), and thoracic endovascular aortic repair (TEVAR) covering the aortic arch, aberrant right subclavian artery origin, and type B aortic dissection (TBAD) without evidence of endoleak (C). B, Upright chest radiograph demonstrating postoperative positioning of the TEVAR stent.
See this image and copyright information in PMC

References

    1. Hughes G.C. Management of acute type B aortic dissection: ADSORB trial. J Thorac Cardiovasc Surg. 2015;149:S158–S162. - PubMed
    1. Wang G.J., Jackson B.M., Foley P.J., Damrauer S.M., Goodney P.P., Kelz R.R., et al. National trends in admissions, repair, and mortality for thoracic aortic aneurysm and type B dissection in the National Inpatient Sample. J Vasc Surg. 2018;67:1649–1658. - PubMed
    1. Vallabhajosyula P., Szeto W., Desai N., Bavaria J.E. Type I and type II hybrid aortic arch replacement: postoperative and mid-term outcome analysis. Ann Cardiothorac Surg. 2013;2:280–287. - PMC - PubMed
    1. Sultan I., Bavaria J.E., Szeto W. Hybrid techniques for aortic arch aneurysm repair. Semin Cardiothorac Vasc Anesth. 2016;20:327–332. - PubMed
    1. Hughes G.C. Classic hybrid arch debranching (type I hybrid arch repair) without circulatory arrest. Ann Cardiothorac Surg. 2018;7:443–450. - PMC - PubMed

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