title: Hybrid endovascular repair of an aneurysmal chronic type B dissection in a patient with Marfan syndrome with an aberrant right subclavian artery.
abstract: 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.
authors.affiliation: Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom. dg.coops@lineone.net
authors.forename: David G
authors.initials: DG
authors.lastname: Cooper
authors.forename: Shiraz
authors.initials: S
authors.lastname: Markur
authors.forename: Stewart R
authors.initials: SR
authors.lastname: Walsh
authors.forename: Claire
authors.initials: C
authors.lastname: Cousins
authors.forename: Paul D
authors.initials: PD
authors.lastname: Hayes
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Boyle
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008382:Marfan Syndrome / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D015607:Stents; D013348:Subclavian Artery / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome