[Total Arch Replacement and Open Stent Grafting for Stanford Type A Acute Aortic Dissection with an Aberrant Left...

A 61-year-old man was referred to our hospital for Stanford type A acute aortic dissection and an emergency operation was planned. In this case, the aberrant left vertebral artery originated directly from the aortic arch. Total arch replacement at the level between the left carotid artery and left aberrant vertebral artery was performed and an open stent graft was deployed in the true lumen of the descending aorta to obtain better distal aortic remodeling. The proximal edge of the nitinol skeleton of the open stent graft was placed distal to the orifice of the left subclavian artery. The left subclavian artery was not reconstructed in the mediastinum but bypassed distally to the left axillary artery so that the left subclavian artery could perfuse the aberrant left vertebral artery through the preserved aortic arch. Patency of all arch branches including the aberrant left vertebral artery was confirmed in postoperative computed tomography( CT) angiography.