Open surgery for acute aortic dissection involving the right aortic arch complicated by an aberrant left subclavian artery, Kommerell diverticulum, and descending aortic aneurysm

Abstract

We report a case of an open surgery for acute aortic dissection involving the right aortic arch with an aberrant left subclavian artery, a Kommerell diverticulum, and a descending aortic aneurysm. We judged that stent grafting was anatomically unsuitable and performed graft replacement via right thoracotomy. Although in situ reconstruction of the aberrant subclavian artery was not achieved owing to the vulnerability of the dissected vessel wall, the patient recovered without associated ischemic symptoms. Graft replacement via lateral thoracotomy remains an important option for acute aortic dissection involving an aberrant subclavian artery and a Kommerell diverticulum. However, an optimal strategy that considers the reconstruction of the aberrant subclavian artery is required.