■右侧主动脉弓(RAArch)约占人群的0.1%。Kommerell憩室(KD),背侧主动脉弓的残余通常是指在异常左锁骨下动脉(ALSA)的起源处的动脉瘤性主动脉扩大,并且与主动脉夹层的风险增加相关.
■一名59岁的女性吸烟者,有高血压和高胆固醇血症史,有24小时的突然发作和严重的刺伤性胸痛放射到肩胛骨间区域。体格检查是正常的,除了双侧基底的蠕动。计算机断层扫描血管造影(CTA)显示RAArch中的B型主动脉夹层,由KD引起的ALSA,伴有主动脉周围血肿和血胸,无任何活动性造影剂外渗。医疗稳定后,使用右颈动脉-锁骨下搭桥术进行了半紧急混合修复,胸主动脉腔内修复术(TEVAR),左锁骨下动脉的栓塞,左臂严重缺血导致的左颈动脉-锁骨下分流术。术后CTA显示存在旁路,主动脉重塑,和ALSA水平的最小IIa型内漏。
■在B型夹层和KD患者中,包括TEVAR在内的混合修复术在对患者独特的解剖结构进行术前仔细评估后是可行的,与开放手术相比,可以降低术后发病率和死亡率.无症状的RAArch和KD患者可考虑预防性修复。
UNASSIGNED: A right-sided aortic arch (RAArch) is present in approximately 0.1% of the population. A Kommerell\'s diverticulum (KD), a remnant of the dorsal aortic arch usually refers to an aneurysmal aortic enlargement at the origin of an aberrant left subclavian artery (ALSA) and is associated with an increased risk of aortic dissection.
UNASSIGNED: A 59-year-old female smoker with a history of hypertension and hypercholesterolaemia presented with a 24-hour history of sudden-onset and severe stabbing chest pain radiating to the interscapular region. Physical examination was normal except for bilateral basal crepitations. Computed tomography angiography (CTA) showed a type B aortic dissection in a RAArch with an ALSA arising from KD with a peri-aortic haematoma and haemothorax without any active contrast extravasation. After medical stabilization, a semi-urgent hybrid repair was performed with a right carotid-subclavian bypass, thoracic endovascular aortic repair (TEVAR), a plug in the left subclavian artery, and left carotid-subclavian bypass due to severe ischaemia of the left arm. The postoperative CTA showed patent bypasses, aortic remodelling, and a minimal type IIa endoleak at the level of the ALSA.
UNASSIGNED: In patients with a type B dissection and KD, hybrid repair including TEVAR is feasible after careful pre-operative assessment of the patient\'s unique anatomy and may reduce post-surgical morbidity and mortality compared to open surgery. Prophylactic repair may be considered in patients with an asymptomatic RAArch and KD.