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Updated: Nov 9, 2025
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Complex endovascular repair of type B aortic dissection and predicting left arm ischemia: a case report
Kevin G Kim1, Anthony N Grieff1, Saum Rahimi2
1Division of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson School of Medicine, One Robert Wood Johnson Place, MEB 541, New Brunswick, NJ, 08901, USA.
Background:
Thoracic endovascular aortic repair (TEVAR) is the gold standard for surgical management of descending thoracic aortic pathology. Depending on the anatomy, TEVAR often requires deployment across the origin of the left subclavian artery (LSA) to obtain a proximal seal, thus potentially compromising perfusion to the left upper extremity (LUE). However, in most patients this is generally well tolerated without revascularization due to collateralization from the left vertebral artery (LVA).
Case Presentation:
We present a complex 59-year-old Caucasian patient case of TEVAR with a history of prior arch debranching and intraoperative LSA coverage requiring subsequent LSA embolization and emergency take-back for left carotid-subclavian bypass.
Conclusion:
The purpose of this case report is to highlight an often overlooked anatomic LVA variant and an atypical, delayed presentation of acute LUE limb ischemia.
