This article has Open Peer Review reports available.
Endovascular repair of a type B aortic dissection with a right-sided aortic arch: case report
© Zhou; licensee BioMed Central Ltd. 2013
Received: 25 January 2012
Accepted: 21 January 2013
Published: 23 January 2013
Right-sided aortic arch is a rare anomaly, and aortic dissection involving a right-sided aortic arch is extremely rare. We report the case of a 65-year-old man with a right-sided aortic arch and a right descending aortic dissection and a stent-graft was accurately deployed without perioperative complications. There were no any complaints and complications after 18 months follow-up. The CTA demonstrated that the false lumen was largely thrombosed only with a mild type II endoleak and a mild descending aortic expansion. We feel that endovascular repair is feasible to patient of type B aortic dissection with a right-sided aortic arch. However, long-term clinical efficacy and safety have yet to be confirmed.
Right-sided aortic arch is a rare anomaly, and aortic dissection involving a right-sided aortic arch is extremely rare. To our knowledge, previous reports that we have identified in English literature include only fifteen cases of aortic dissection involving a right-sided aortic arch (through a Medline database search from 1966 to October 2011 and the search strategy “right-sided aortic arch and aortic dissection”) and they were performed with traditional surgical procedures except for one report has described endovascular treatment . We are presenting a case of type B aortic dissection associated with a right-sided aortic arch and aberrant left subclavian artery, in which a successful endovascular stent-graft placement was performed.
Right-sided aortic arch occurs in approximately 0.1% of the population. There are three major types . Type I, with mirror-imaged branching of the major arteries. Type II, with aberrant subclavian artery. The ordering of the aortic arch branches as left common carotid, right common carotid, right subclavian, and LSA arising from Kommerell’s diverticulum from proximal to distal. Type III, with isolation of the subclavian artery. Type I represent 59% of all right aortic arches, type II 39.5%, and type III 0.8%.
In 1994, Dake and colleages  first reported successful transluminal placement of endovascular stent-grafts for the treatment of aortic dissection, and showed good early results. This technique is less invasive than traditional surgery with acceptable morbidity and mortality rates. Endovascular treatment of right-sided aortic arch aneurysms is appealing because it avoids a thoracotomy or median sternotomy, and it obviates the need for circulatory arrest, which is commonly required with the conventional approach. Okada and associates  demonstrated the feasibility of endovascular repair in a 76-year-old man with an aneurysm that involved a right-sided aortic arch. Naoum and colleagues  described the successful surgical repair in a 58-year-old man of descending thoracic aortic aneurysm with a right-sided aortic arch by the combined use of a left carotid to subclavian artery bypass followed by endovascular stent-graft placement. Yamazaki  first reported a successful stent-graft treatment in a 56-year-old man suffered from type B aortic dissection involving a right aortic arch. In the present case, the anatomic features made the landing zone between the right subclavian artery and the thoracic aortic intimal tear long enough to accommodate a stent-graft without causing basal artery ischemia. And let the “C” arm in right anterior oblique (RAO) 45° other than left anterior oblique (LAO) to unfold the aortic arch intraoperatively. After 18 months follow-up, there is no dizzy, no swoon, no left upper extremity necrosis, no extremities myodynamia degrade, no nervous system complications, and no dysphagia stridor. However, a mild type II endoleak and a mild descending aortic expansion most probably come from the LSA back-flow. We are planning to followup of the type II endoleak and aortic expansion, and ligate or embolize the LSA when necessary.
Although early results are promising, long-term clinical efficacy and safety have yet to be confirmed.
Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
The author thanks Jiang Junhao,MD for retouching the manuscript.
- Cinà CS, Arena GO, Bruin G, Clase CM: Kommerell’s diverticulum and aneurysmal right-sided aortic arch: a case report and review of the literature. J Vasc Surg. 2000, 32: 1208-1214. 10.1067/mva.2000.108012.View ArticlePubMedGoogle Scholar
- Yamazaki I, Imoto K, Ichkawa Y: Stent-graft treatment of type B aortic dissection involving the right aortic arch (case report). Jpn Circ J. 2000, 64: 727-728. 10.1253/jcj.64.727.View ArticlePubMedGoogle Scholar
- Dake MD, Miller MC, Semba CP, Mitchell RS, Walker PJ, Liddell RP: Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med. 1994, 331 (26): 1729-1734. 10.1056/NEJM199412293312601.View ArticlePubMedGoogle Scholar
- Okada K, Sueda T, Orihashi K, Watari M, Naito A: Endovascular stent-graft repair for thoracic aortic aneurysm associated with right-sided aortic arch. J Thorac Cardiovasc Surg. 2001, 122: 185-186. 10.1067/mtc.2001.113019.View ArticlePubMedGoogle Scholar
- Naoum JJ, Parenti JL, LeMaire SA, Coselli JS: Endovascular repair of a right-sided descending thoracic aortic aneurysm with a right-sided aortic arch and aberrant left subclavian artery. Ann Thorac Surg. 2008, 85: 1074-1076. 10.1016/j.athoracsur.2007.09.032.View ArticlePubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.