Acute aortic dissection with an aberrant right subclavian artery resulting in rapid false lumen enlargement: a case report.

BACKGROUND

An aberrant right subclavian artery complicated by acute aortic dissection has been reported. Aneurysmal degeneration in the descending aorta adjacent to the Kommerell diverticulum in older patients has also been reported. There are concerns regarding the anatomic and pathological aspects of an aberrant right subclavian artery accompanying the Kommerell diverticulum with respect the surgical strategy for acute aortic dissection.

CASE PRESENTATION: We report the case of a 79-year-old man with an aberrant right subclavian artery who developed acute aortic dissection (DeBakey IIIa) and rapid enlargement of the false lumen with deteriorating dysphagia and back pain. Total arch replacement with the frozen elephant trunk technique was performed. The aberrant right subclavian artery was closed using a stent graft proximally and was ligated distally at the right side of the posterior mediastinum. To prevent injury to the esophagus, the aberrant right subclavian artery was identified by lifting the right side of the thoracic wall using a thoracotomy device for internal thoracic artery harvest to expose the dorsal circumference of the superior vena cava. Additionally, the right subclavian artery was reconstructed using an extra-anatomical bypass.

CONCLUSIONS

This surgical strategy could be useful in patients with an aberrant right subclavian artery and the Kommerell diverticulum who require total arch replacement.