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Aortic dissection in the presence of an aberrant right subclavian artery

Edgar D Guzman1, Matthew J Eagleton

  • 1Cleveland Clinic Foundation, Cleveland, OH 44195, USA. edgar_guzman@sbcglobal.net

Annals of Vascular Surgery
|July 17, 2012
PubMed

Insights

Aberrant right subclavian arteries can complicate aortic dissections. Hybrid endovascular and open surgical techniques effectively treat these complex aortic arch anomalies, preserving essential blood flow.

Area of Science:

  • Vascular Surgery
  • Cardiovascular Imaging
  • Interventional Cardiology

Background:

  • Aberrant right subclavian artery (ARSA) is a common aortic arch anomaly.
  • ARSA can be involved in aortic dissections, leading to complications like flow limitation and aneurysmal degeneration.
  • Managing ARSA in the context of aortic dissection requires specialized endovascular and surgical strategies.

Observation:

  • This report details the management of four patients with ARSA and aortic dissection.
  • Two patients were treated with a purely endovascular approach.
  • Two patients underwent proximal open surgical repair followed by distal stent grafting.

Findings:

  • The ostium of the aberrant right subclavian artery was covered in all cases.
  • Antegrade flow into the right subclavian artery was preserved using extra-anatomic bypass.
  • End-to-side bypasses facilitated transbrachial endovascular access for embolization, preserving the right vertebral artery.

Implications:

  • Hybrid approaches combining open and endovascular techniques offer effective treatment for ARSA-associated aortic dissections.
  • These hybrid strategies minimize the extent of open surgical repair.
  • Successful management preserves antegrade flow and protects critical branch arteries.

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