PMC6441505_01
Preoperative chest CT showing type B aortic dissection from the origin of the left subclavian artery.
CRIS2019-7927613.001.jpg
PMC6441505_01_CRIS2019-7927613.001.jpg
fig1
There was no other evidence of vascular dissection or occlusion below the level of the renal arteries (Figures 1 and 2).
Preoperative virtual 3D CT angiogram of the aorta showing the separate origin of the left vertebral artery from the aortic arch.
CRIS2019-7927613.002.jpg
PMC6441505_01_CRIS2019-7927613.002.jpg
fig2
There was no other evidence of vascular dissection or occlusion below the level of the renal arteries (Figures 1 and 2).
Intraoperative angiogram after stent placement.
CRIS2019-7927613.003.jpg
PMC6441505_01_CRIS2019-7927613.003.jpg
fig3
The patient underwent general anesthesia for thoracic endovascular repair (TEVAR) two days after his first day of admission; the procedure was done through the right femoral approach; an angiogram was performed intraoperatively (Figure 3).
Postoperative axial CT angiography.
CRIS2019-7927613.004.jpg
PMC6441505_01_CRIS2019-7927613.004.jpg
fig4
We evaluated patient's prognosis by following up for 3 to 6 months for a chest X-ray, CTA, and CT aorta 3D reconstruction (Figures 4 and 5) which confirmed no endovascular leak as well as no ischemic or stroke signs in the clinical follow-up; we assessed the patency of the subclavian arteries by examining the bilateral upper arms' blood supply in addition to radial arteries by evaluating the pulses with no evidence of morbidity.
Postoperative CT aorta 3D reconstruction posterior view showing Kommerell's diverticulum (1), patent right aberrant subclavian artery (2), left subclavian artery (3), and a stent inside the descending aorta (4).
CRIS2019-7927613.005.jpg
PMC6441505_01_CRIS2019-7927613.005.jpg
fig5
We evaluated patient's prognosis by following up for 3 to 6 months for a chest X-ray, CTA, and CT aorta 3D reconstruction (Figures 4 and 5) which confirmed no endovascular leak as well as no ischemic or stroke signs in the clinical follow-up; we assessed the patency of the subclavian arteries by examining the bilateral upper arms' blood supply in addition to radial arteries by evaluating the pulses with no evidence of morbidity.