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Novel and Innovative Hybrid Technique for Type A Aortic Dissection

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A new inclusion technique through an upper partial sternotomy for complicated Stanford B-type aortic dissection with

Maoxun Huang¹, Hulin Piao, Bo Li

¹Department of Cardiovascular Surgery, Second Hospital of Jilin University, Changchun, Jilin, China.

|March 19, 2019

Abstract

Rationale:

An aberrant right subclavian artery (ARSA), arising from the proximal descending aorta, is a common aortic arch anomaly, with an incidence of 0.5% to 2%. However, coexistence of dissection and an ARSA is extremely rare. We presented the first case of successful management of complicated Stanford B-type aortic dissection combined with an ARSA with a new inclusion technique and stent graft (SG) implantation through an upper partial sternotomy.

Patient Concerns:

A 39-year-old woman with a history of severe hypertension was admitted to our hospital because of sudden-onset chest and upper back pain.

Diagnoses:

Aortic computed tomography angiography (CTA) demonstrated complicated Stanford B-type dissection with ARSA.

Interventions:

A new inclusion technique and SG implantation through an upper partial sternotomy were performed for the patient, whose aortic arch branch vessels, including ARSA, were fully preserved.

Outcomes:

The patient had an uneventful postoperative course without neurologic deficits, and no blood transfusion was required during the hospitalization. The false lumen completely disappeared on postoperative CTA.

Lessons:

This new inclusion technique through an upper partial sternotomy is a safe and feasible treatment for complicated Stanford B-type aortic dissection with an ARSA with the primary tear located in the aortic arch.

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