Hybrid management of type B aortic dissection in a patient with right-sided aortic arch and aberrant left subclavian artery.

P0149 

Abstract Submission 

Lucas Ribe (1), Regina Husman (2), Yuki Ikeno (1), Madiha hassan (3), Rana Afifi (4), Anthony Estrera (5)

(1) McGovern Medical School at UTHealth, Houston, TX, (2) Memorial Hermann Hospital. UTHealth., Houston, TX, (3) Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, TX, (4) Memorial Hermann, Houston, TX, (5) Memorial Hermann Heart and Vascular Institute, Houston, TX

Lucas Ribe    -  Contact Me
McGovern Medical School at UTHealth

Regina Husman    -  Contact Me
Memorial Hermann Hospital. UTHealth.

Yuki Ikeno    -  Contact Me
McGovern Medical School at UTHealth

Madiha hassan    -  Contact Me
Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth

Rana Afifi    -  Contact Me
Memorial Hermann

*Anthony Estrera    -  Contact Me
Memorial Hermann Heart and Vascular Institute

Lucas Ribe    -  Contact Me
McGovern Medical School at UTHealth

Objective:

We report a hybrid repair of a right-sided aortic arch and an aberrant left subclavian artery associated with a Kommerell diverticulum.

Methods:

A 58- year- old was evaluated for acute-onset chest pain and shortness of breath. A computed tomographic angiography (CTA) of the chest, abdomen, and pelvis revealed a right-sided aortic arch and an aberrant left subclavian artery (ALSA) associated with a Kommerell diverticulum measuring 3.6 cm. Aneurysmal degeneration of the descending aorta measured 6.0 cm. An acute type B (zones 2-10) aortic dissection was identified.

Results:

The patient underwent open repair with explantation of the infected TEVAR, extensive periaortic debridement, graft replacement with a dacron graft, and complete coverage with a latissimus dorsi muscle flap.
In the second stage, we performed a thoracic endovascular aneurysm repair (TEVAR), which was deployed in the elephant trunk with a 4-cm proximal overlap.
At 1-year follow-up, he demonstrated symptoms of left upper extremity and vertebrobasilar ischemia. Therefore, a left common carotid to subclavian artery bypass was performed.
CT scan during follow-up shows no aneurysmal growth, with an aortic size over the past 3 years unchanged, at 2.9 cm.

Conclusions:

Our patient's successful management after hybrid repair of a right aortic arch and ALSA depended on meticulous preoperative planning with a multidisciplinary team. Careful evaluation of individual's unique anatomy and presenting symptoms is essential.

Aortic Arch