[Surgical therapy of ruptured aortic aneurysm involving a Shuford type-3 right-sided aortic arch]

A 64-year-old man was admitted to our hospital with a complaint of severe back pain of sudden onset on Nov. 2, 1988. Aortogram and chest-CT demonstrated a ruptured dissecting aortic aneurysm involving a Shuford type-3 right-sided aortic arch. Emergency operation was done under temporary brachio-femoral arterial bypass. The thoracic aorta was transected distal to an aberrant left subclavian artery. The entry which located proximal to the aberrant subclavian artery was closed by two u-stay sutures with pledgets. The transected aorta was closed and reinforced with Sandwich method using Teflon-felt. The false lumen completely disappeared on chest-CT on 36th day postoperatively, and the patient is now doing well, although re-thoracotomy was necessary because of post-operative bleeding. To our knowledge, this is the first case of repair of a ruptured dissecting aortic aneurysm involving a right-sided aortic arch which is reported to be very rare.