title: Repair of complicated type B dissection with an aberrant right subclavian artery.
abstract: An aberrant right subclavian artery (ARSA) is one of most common congenital anomalies, but the coexistence of type B dissection and an ARSA is extremely rare. Repair of type B dissection poses a technical challenge due to an ARSA. We retrospectively reviewed our experience of surgical treatment of a complicated type B dissection with an ARSA.
  
  
  
  From August 2010 to March 2014, 7 patients with chronic type B dissection with an ARSA underwent the stented elephant trunk procedure under hypothermic cardiopulmonary bypass in our centre. The mean age was 45 ± 7 (range, 32-54) years. Total arch replacement was performed in 2 patients. Revascularization of the ARSA was done in 5 of 7 patients.
  
  
  
  There were no in-hospital deaths. The mean time of mechanical ventilation and stay in the intensive care unit was 22 ± 11 and 53 ± 11 h, respectively. Neurological deficit, visceral ischaemia or injury to the spinal cord was not observed. Right upper-limb ischaemia was not observed in patients without ARRA revascularization during follow-up.
  
  
  
  In patients not undergoing descending aortic replacement, the stented elephant trunk method is our preferred procedure for this anomaly via a median sternotomy. Repair of type B dissection and revascularization of the ARSA were achieved in a single stage using this technique. Satisfactory surgical results and follow-up outcomes were obtained. There was no right upper-limb ischaemia or neurological deficit in patients without ARSA revascularization, but revascularization of the ARSA is recommended for this vessel anomaly.
authors.affiliation: Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Jun-Ming
authors.initials: JM
authors.lastname: Zhu
authors.affiliation: Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Rui-Dong
authors.initials: RD
authors.lastname: Qi
authors.affiliation: Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Yong-Min
authors.initials: YM
authors.lastname: Liu
authors.affiliation: Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zheng
authors.affiliation: Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Xiao-Yan
authors.initials: XY
authors.lastname: Xing
authors.affiliation: Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China lizhongsun@outlook.com.
authors.forename: Li-Zhong
authors.initials: LZ
authors.lastname: Sun
mesh_terms: D000328:Adult; D000783:Aneurysm / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D018376:Cardiovascular Abnormalities / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003680:Deglutition Disorders / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013348:Subclavian Artery / Q000002:abnormalities* / Q000601:surgery; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: Aberrant right subclavian artery; Complicated type B dissection; Stented elephant trunk procedure