Guzman Edgar D, Eagleton Matthew J
Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Ann Vasc Surg. 2012 Aug;26(6):860.e13-8. doi: 10.1016/j.avsg.2012.01.011.
The presence of an aberrant right subclavian artery arising from the proximal descending aorta is a relatively common anomaly of the aortic arch. These vessels may be involved in aortic dissections, either as the site of the primary intimal tear or as a dissected aortic branch, subject to flow limitation and future aneurysmal degeneration. In this report, we review our experience in treating these lesions in the endovascular era. In two cases, the dissected aorta was treated with an endovascular approach, whereas in two others, proximal open surgical repair was followed by distal stent grafting. The ostium of the aberrant vessel was covered in all cases. Preservation of antegrade flow into the right subclavian was obtained via extra-anatomic bypass. Creation of end-to-side bypasses as opposed to transpositions allowed transbrachial endovascular access to the aberrant right subclavian artery with the purpose of embolization while preserving the right vertebral artery. The hybrid approaches described here effectively address the aortic dissection and degenerative changes associated with an aberrant right subclavian artery while minimizing the need for extensive open repair.
起源于近端降主动脉的迷走右锁骨下动脉是一种相对常见的主动脉弓异常。这些血管可能参与主动脉夹层，既可以作为原发性内膜撕裂的部位，也可以作为被夹层累及的主动脉分支，存在血流受限和未来动脉瘤样退变的风险。在本报告中，我们回顾了在血管腔内治疗时代处理这些病变的经验。在两例病例中，采用血管腔内方法治疗夹层主动脉，而在另外两例中，先进行近端开放手术修复，然后进行远端支架植入。所有病例中异常血管的开口均被覆盖。通过解剖外旁路实现了右锁骨下动脉顺行血流的保留。与血管转位相反，采用端侧旁路的方式使得经肱动脉血管腔内途径能够进入迷走右锁骨下动脉以进行栓塞，同时保留右椎动脉。本文所述的杂交手术方法有效地解决了与迷走右锁骨下动脉相关的主动脉夹层和退行性改变，同时最大限度地减少了广泛开放修复的必要性。
