Aortic Dissection in the Presence of an Aberrant Right Subclavian Artery

The presence of an aberrant right subclavian artery arising from the proximal descending aorta is a relatively common anomaly of the aortic arch. These vessels may be involved in aortic dissections, either as the site of the primary intimal tear or as a dissected aortic branch, subject to flow limitation and future aneurysmal degeneration. In this report, we review our experience in treating these lesions in the endovascular era. In two cases, the dissected aorta was treated with an endovascular approach, whereas in two others, proximal open surgical repair was followed by distal stent grafting. The ostium of the aberrant vessel was covered in all cases. Preservation of antegrade flow into the right subclavian was obtained via extra-anatomic bypass. Creation of end-to-side bypasses as opposed to transpositions allowed transbrachial endovascular access to the aberrant right subclavian artery with the purpose of embolization while preserving the right vertebral artery. The hybrid approaches described here effectively address the aortic dissection and degenerative changes associated with an aberrant right subclavian artery while minimizing the need for extensive open repair.