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Ann Thorac Surg 2012;94:639-641. doi:10.1016/j.athoracsur.2011.12.082
© 2012 The Society of Thoracic Surgeons
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Case Reports

Hybrid Endovascular Treatment of an Anomalous Right Subclavian Artery Dissection in a Patient With Marfan Syndrome

Gregory A. Stanley, MDa, Frank R. Arko, III, MDa, Mazin I. Foteh, MDa, Michael E. Jessen, MDb, J. Michael DiMaio, MDb,*

a Division of Vascular and Endovascular Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
b Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas

Accepted for publication December 19, 2011.

* Address correspondence to Dr DiMaio, Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, 5909 Harry Hines Blvd, 9th Fl, Ste 134, Dallas, TX 75390-8879 (Email: michael.dimaio{at}utsouthwestern.edu).

We report the case of a 26-year-old female patient with Marfan syndrome and an aberrant right subclavian artery (ARSA) with associated Kommerell diverticulum. The patient presented with spontaneous acute dissection of the ARSA that showed fusiform dilation to 4 cm in diameter. Definitive treatment was performed using a two-stage hybrid endovascular technique, including extrathoracic bilateral upper extremity bypass and thoracic endovascular aortic repair with debranching of the right and left subclavian arteries. This was followed by coil and plug embolization to exclude the dissection and prevent subsequent endoleak.






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