Dissection of a right-sided aortic arch with aberrant left subclavian artery is a rare entity without consensus for gold standard treatment. Only few cases were described with different surgical strategies such as total arch replacement with TEVAR or frozen elephant trunk. Here we present a case of type A aortic dissection of right-sided aortic arch treated in an hybrid approach.

A 49-year-old man was admitted to our hospital for acute chest pain with neck irradiation. Computed tomography (CT) demonstrated acute type A aortic dissection extending to descendant thoracic aorta in a right-sided aortic arch with aberrant left subclavian artery originating from Kommel's diverticulum (KD). The patient underwent replacement of the ascending aorta (24mm straight tube) and stenting of the aortic arch (40mm hybrid AMDS stent) under extracorporeal circulation with cannulation of the right femoral artery and semi-selective cerebral perfusion through the left carotid artery.

The postoperative course was uneventful. CT – scan on POD 5 revealed obliteration of the false lumen in the arch and in the distal descending thoracic aorta with persistent opacification of the false lumen of in front of the left subclavian artery probably related to a widening of the aorta due to KD, with a cross-sectional diameter at the origin of the left subclavian measuring less than 2cm. The patient was discharged home on POD 11 and he remains well.

To our knowledge, there is no study describing right-sided aortic arch dissection treated with interposition graft of the ascending aorta and hybrid AMDS stent placement. Our case demonstrate a good intra-operativ and short-term result without increasing technical complexity. This approach could represent an interesting alternative to the emergency management of this rare anatomical variation with good opening of the true lumen, reducing perfusion of the false lumen and stabilization of the aortic diameter without compromise of the perfusion of the supra-aortic trunks. Naturally close follow-up is necessary for long-term result.