P149. Hybrid Management of Type B Aortic Dissection in a Patient with Right-sided Aortic Arch and Aberrant Left Subclavian Artery.
McGovern Medical School at UTHealth
Houston, TX
United States - Contact Me
Avanced Aortic Surgery Fellow at Memorial Hermann Hospital, Houston.
I currently live in Houston, where I am completing a two- year Fellowship in advanced aortic surgery. I am greatly engaged in open surgery for aortic aneurysms and dissections, as well as in modern vascular surgery, with large interest in vascular innovations, latest technology in vascular and aortic endovascular surgery, and greatly interested in medical and academic education, as well as surgical simulation.
I previously joined La Fe University Hospital in 2014 as a junior physician in angiology and vascular surgery, within the department of vascular surgery.
Prior to La Fe, I was the first Spanish junior vascular surgeon to complete a senior clinical Fellowship in aortic surgery at St. Mary’s Hospital, Imperial College of London, during an 18- month period,
and one of the first Spanish surgeons to become an official fellow of the European board of vascular and endovascular surgery (FEBVS).
Prior to this experience, I completed my residency in vascular surgery at Gregorio Marañón University hospital in Madrid, during a five- year period.
During my tenure in Madrid, I helped the hospital with the medical and residents training program, and participated in several national and international simulation courses, workshops, and meetings.
I am a graduate of the University of Alcala in Madrid, where I majored my bachelor in medicine.
Description
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.
Authors
Lucas Ribe (1), Regina Husman (2), Yuki Ikeno (1), Madiha hassan (3), Rana Afifi (4), Anthony Estrera (5)
Institutions
(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