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Pre-operative axial image (A) and three-dimensional volume-rendered images (B [anterior view] & C [posterior view]) from computed tomography angiogram demonstrating an aortic aneurysm confined to the proximal descending thoracic aorta with evidence of contained rupture, an acute type B thoracic aortic dissection and the presence of a right-sided aortic arch.
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The left common carotid artery arose proximally on the arch and was uninvolved (Fig. 1).
Digital subtraction angiography in a steep left anterior oblique projection demonstrating the right-sided aortic arch and ruptured aneurysm prior to (A) and following thoracic stent graft exclusion.
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Arizona) was placed in proximal descending thoracic aorta covering the left SCA (Fig. 2).
Axial image from computed tomography angiogram (A) and digital subtraction angiography (DSA) demonstrating a type IB endoleak due to degeneration of the distal descending thoracic aorta. DSA confirming successful stent graft exclusion of the type IB endoleak.
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To exclude the endoleak, the repair was extended distally using a repeat percutaneous approach and a 38 mm by 107 mm long Medtronic Valiant  thoracic stent graft (Minneapolis, Minnesota) (Fig. 3).
Digital subtraction angiography demonstrating a retrograde endoleak from the left subclavian artery (A) and successful coil embolization of the left subclavian artery to treat the retrograde endoleak (B).
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Six months later, the left subclavian artery was coil embolized to treat an additional retrograde (Type II) endoleak (Fig. 4).
Three-dimensional volume-rendered images (A [anterior view] & B [posterior view]) from computed tomography angiogram demonstrating a completed successful totally percutaneous repair of a ruptured thoracic aortic dissection with a right sided aortic arch.
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The patient has done well with no further evidence of endoleak or aneurysm expansion (Fig. 5).