Atresia of the right vertebral artery in a patient with acute aortic dissection.

A 49-year-old man had severe neurocognitive dysfunction after urgent operation for acute type A aortic dissection. Complete aortic arch replacement with single reimplantation of the arch branches was performed with the patient under deep hypothermic circulatory arrest. Retrospectively, my colleagues and I consider the atresia of the right vertebral artery to be responsible for this complication and discuss whether knowledge of the anomaly and adapting the operative strategy accordingly would have improved the neurologic outcome.