Open surgical repair of complex non-Type A and non-Type B aortic dissection in a right aortic arch-case report

To report the diagnostic and treatment process of a patient with complex non-Type A and non-Type B aortic dissection, and to discuss its clinical characteristics and surgical strategy.

A retrospective analysis was conducted on the clinical data of a patient with complex non-Type A and non-Type B aortic dissection.

After admission, the patient was diagnosed with complex non-Type A and non-Type B aortic dissection through computed tomography angiography (CTA). The aorta exhibited a right-sided arch, with the left common carotid artery originating from the ascending aorta and the aberrant left subclavian artery arising from the distal aortic arch. The right vertebral artery originated from the right-sided aortic arch. The dissection tear was located at the distal part of the aortic isthmus, approximately 2 cm in width. The dissection flap extended proximally to the distal aspect of the right subclavian artery origin and distally to the proximal aspect of the left renal artery origin. Due to the high difficulty of endovascular repair and the increased risk of long-term complications, an open surgical approach was chosen. This involved deep hypothermic circulatory arrest with elephant trunk stenting, left common carotid to left subclavian artery bypass. The patient was discharged one week after surgery in good health.

This case illustrates that open surgical repair can be a feasible and effective option for selected patients with non-A non-B aortic dissection and complex arch anatomy that limits endovascular repair. Treatment should be individualized according to entry-tear location, arch-branch anatomy, landing-zone feasibility, malperfusion risk, and institutional expertise. Due to the special anatomical structure and high surgical difficulty, a personalized treatment plan must be developed. Open surgery still offers irreplaceable advantages in certain cases.