Aortic dissection originating from an aberrant right subclavian artery

Li, Qing-Le; Zhang, Xiaoming; Zhang, Xuemin

doi:10.1016/j.jvs.2007.06.042

Cited by 9 publications

(4 citation statements)

References 15 publications

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“…The final review included eight relevant case series 4 5 6 7 8 9 10 11 and 24 single case reports 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 comprising a total of 85 patients ( Fig. 2 ).…”

Section: Resultsmentioning

confidence: 99%

How to Treat Type B Aortic Dissections in the Presence of an Aberrant Right Subclavian Artery: A Systematic Review

et al. 2023

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An aberrant right subclavian artery (ARSA) is the most common congenital variant of the aortic arch. Usually, this variation is largely asymptomatic, but sometimes it may be involved in aortic dissection (AD). Surgical management of this condition is challenging. The therapeutic options have been enriched in recent decades by establishing individualized endovascular or hybrid procedures. Whether these less invasive approaches bear advantages, and how they have changed the treatment of this rare pathology, is still unclear. Therefore, we conducted a systematic review. We performed a review of literature from the past 20 years (from January 2000 until February 2021) complying with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. All reported patients treated for Type B AD in the presence of an ARSA were identified and classified into three groups according to the received therapy (open, hybrid, and total endovascular). Patient characteristics, as well as in-hospital mortality, and major and minor complications were determined and statistically analyzed. We identified 32 relevant publications comprising 85 patients. Open arch repair has been offered to younger patients, but significantly less often in symptomatic patients needing urgent repair. Therefore, the maximum aortic diameter was also significantly larger in the open repair group compared with that in the hybrid or total endovascular repair group. Regarding the endpoints, we did not find significant differences. The literature review revealed that open surgical therapies are preferred in patients presenting with chronic dissections and larger aortic diameters, most likely because they are unsuitable for endovascular aortic repair. Hybrid and total endovascular approaches are more often applied in emergency situations, where aortic diameters remain smaller. All therapies demonstrated good, early, and midterm outcomes. But, these therapies carry potential risks in the long term. Therefore, long-term follow-up data are urgently needed to validate that these therapies are sustainable.

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Section: Resultsmentioning

confidence: 99%

How to Treat Type B Aortic Dissections in the Presence of an Aberrant Right Subclavian Artery: A Systematic Review

et al. 2023

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“…There are a number of reports in the literature of treating acute aortic dissection associated with an aberrant right subclavian artery using endovascular techniques. [17][18][19][20] These have generally involved covering the entry point and excluding the aberrant vessel to achieve thrombosis of the false lumen with or without transposition. Chan et al described a very similar case in a non-Marfanoid 70-year-old man with a thoracoabdominal aneurysm from a type B dissection and associated aberrant right subclavian.…”

Section: Discussionmentioning

confidence: 99%

Hybrid Endovascular Repair of an Aneurysmal Chronic Type B Dissection in a Patient with Marfan Syndrome With an Aberrant Right Subclavian Artery

Cooper

Markur

Walsh

et al. 2008

Vasc Endovascular Surg

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Abnormal aortic arch anatomy is relatively uncommon but most frequently involves an aberrant right subclavian artery. Rarely, it is associated with aneurysmal dilatation of a chronic type B dissection. Under such circumstances, the abnormal anatomy may complicate therapeutics options. Furthermore, controversy exists regarding the use of surgical or endovascular techniques in patients with aortic aneurysms and underlying arteriopathies. The current literature is limited with regard to reporting of the latter. We present a hybrid approach to repair such an aneurysm in a patient with Marfan syndrome. In a 2-stage procedure, involving initial supra-aortic bypass to all aortic arch branches, followed by endovascular stent graft deployment, the aneurysm was successfully excluded. There were no immediate complications and no evidence of endoleak at 3 months postoperatively, with thrombosis of the false lumen in the chest. By adapting hybrid open and endovascular techniques, complex thoracic aneurysms may be successfully treated in the short term in the presence of an underlying arteriopathy.

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“…Diverse clinical manifestation associated with ARSA have been reported, including dysphagia, dyspnea and retrosternal pain, although most patients are generally asymptomatic[ 4 , 5 ]. Several cases of ARSA associated with procedure-related aortic dissection (AD) treated surgically or conservatively have been reported[ 6 ]. Herein, we report a case of a patient with an incidentally found ARSA during right transradial intervention (TRI), which further resulted in iatrogenic type B AD that was further salvaged by percutaneous angioplasty.…”

Section: Introductionmentioning

confidence: 99%

Iatrogenic aortic dissection during right transradial intervention in a patient with aberrant right subclavian artery: A case report

Ha¹,

Jang²,

Shin³

et al. 2022

WJCC

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BACKGROUND Aberrant right subclavian artery (ARSA) is the most common congenital anomaly of the aortic arch. When patients having such anomalies receive transradial intervention (TRI), aortic dissection (AD) may occur. Herein, we discuss a case of iatrogenic type B AD occurring during right TRI in an ARSA patient, that was later salvaged by percutaneous angioplasty. CASE SUMMARY A 73-year-old man presented to our hospital with intermittent chest pain. Coronary computed tomography (CT) angiography revealed significant stenosis in the left anterior descending artery. Diagnostic coronary angiography was performed via the right radial artery without difficulty. However, we were unable to advance the guiding catheter past the ostium of the right subclavian artery to the aortic arch for percutaneous coronary intervention, while the guidewire tended to go down the descending aorta. The patient suddenly complained of chest and back pain. Emergent CT aortography revealed type B AD propagating to the left renal artery (RA) with preserved renal perfusion. However, after 2 d, the patient suddenly complained of right lower limb pain where the femoral pulse was suddenly undetectable. Follow-up CT indicated further progression of dissection to the right external iliac artery (EIA) and left RA with limited flow. We performed percutaneous angioplasty of the right EIA and left RA without complications. Follow-up CT aortography at 8 mo showed optimal results. CONCLUSION A caution is required during right TRI in ARSA to avoid AD. Percutaneous angioplasty can be a treatment option.

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Aortic dissection originating from an aberrant right subclavian artery

Cited by 9 publications

References 15 publications

How to Treat Type B Aortic Dissections in the Presence of an Aberrant Right Subclavian Artery: A Systematic Review

How to Treat Type B Aortic Dissections in the Presence of an Aberrant Right Subclavian Artery: A Systematic Review

Hybrid Endovascular Repair of an Aneurysmal Chronic Type B Dissection in a Patient with Marfan Syndrome With an Aberrant Right Subclavian Artery

Iatrogenic aortic dissection during right transradial intervention in a patient with aberrant right subclavian artery: A case report

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