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Midterm Outcome of Aortic Dissection Associated With Aberrant Subclavian Artery: A Single-Center Retrospective
Yangxue Sun1, Yuanrui Gu1, Shuo Dong1
1Department of Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Purpose:
The aberrant subclavian artery (aSA) is a rare anomaly of the aortic branches. Approximately 20-60% of patients with an aSA are associated with Kommerell's diverticulum (KD). These vascular anomalies have been reported to increase the risk of aortic rupture (4-19%) and aortic dissection. However, limited studies have investigated the treatment of aortic dissection in patients with aSA and KD. This study aims to investigate clinical characteristics and midterm follow-up outcomes of patients with aortic dissection associated with aSA.
Materials And Methods:
Between 2011 and 2021, a total of 48 patients with aSA anomalies underwent aortic dissection surgical intervention. Surgical interventions include open surgery, hybrid surgery, and endovascular therapy. Among them, 20 (41.7%) had Stanford type A dissection, 9 (18.8%) had Stanford type B dissection, and 19 (39.6%) had non-A non-B dissection. We report the early and midterm clinical outcomes including mortality, central nervous system complication and respiratory complication, and other operative outcomes including reintervention rates and endoleak. A subgroup analysis of the surgical and postoperative conditions was performed on Stanford type B and non-A non-B aortic dissection patients.
Results:
The mean age of the patient population was 48.81±9.65 years. The 30-day mortality rate was 12.5%. The overall mortality rate was 20.8%, with a median follow-up time of 4.5 years (interquartile range [IQR]: 2-8.75 years). Central nervous system complications occurred in 8 patients (16.7%), subclavian steal syndrome in 6 patients (12.5%), and respiratory complications in 3 patients (6.2%). The estimated Kaplan-Meier survival rates at 1 year, 3 years, 5 years, and 7 years after surgery were, respectively, 87.0%, 82.5%, 79.7%, and 75.1%. For Stanford type B and non-A non-B aortic dissection patients, the 30-day mortality rate between the open surgery group and the minimally invasive group had no statistically significant differences (18.3% vs 8.3%, p=0.815).
Conclusions:
Surgical intervention for aSA patients with aortic dissection has poor outcomes. Early intervention might be considered for patients with aSA and KD to prevent the occurrence of aortic dissection.Clinical ImpactAberrant subclavian artery (aSA) and Kommerell's diverticulum (KD) have been reported to increase the risk of aortic rupture and aortic dissection. This study is currently the largest single-center retrospective study on aSA combined with aortic dissection, providing standardized data reporting and midterm follow-up of patients with this rare vascular anomaly.
