Barr JG1, Sepehripour AH2*, AJarral O2, Tsipas P3, Kokotsakis J3, Kourliouros A1 and Athanasiou T2
1Department of Cardiac Surgery, Harefield Hospital, UK
2Department of Cardiothoracic Surgery, Hammersmith Hospital, UK
3Department of Cardiothoracic Surgery, Evangelismos Hospital, Greece
Aneurysms and dissections of the right sided aortic arch are rare and published data is limited to few case reports and small series. The optimal treatment strategy of this entity and the challenges associated with their management are not yet fully investigated and conclusive. We performed a systematic review of the literature to identify all patients who underwent surgical or endovascular intervention for right aortic arch aneurysms or dissections. We focused on presentation and critically assessed different management strategies and outcomes. We identified 74 studies which reported 99 patients undergoing surgical or endovascular intervention for a right aortic arch aneurysm or dissection. Median age was 61 years. The commonest presenting symptoms were chest or back pain and dysphagia. 88 patients had an aberrant LSCA with only 11 patients having the mirror image variant of a right aortic arch. The commonest pathology was aneurysm arising from a Kommerell’s diverticulum occurring in over 50% of the patients. 28 patients had dissections, 19 of these were type B and 9 were type A. 81 patients had elective operations whilst 18 had emergency procedures. 67 patients underwent surgical treatment, 20 patients had hybrid surgical and endovascular procedures and 12 had totally endovascular procedure. There were 5 deaths, 4 of which were in patients undergoing emergency surgery and none in the endovascular repair group. Aneurysms and dissections of a right sided aortic arch are rare. Advances in endovascular treatment and as well hybrid surgical and endovascular management is making this rare pathology amenable to these approaches and may confer improved outcomes compared to conventional extensive repair techniques.
Right sided aortic arch; Kommerell’s diverticulum; Aneurysm; Dissection
Barr JG, Sepehripour AH, AJarral O, Tsipas P, Kokotsakis J, Kourliouros A, et al. Surgical Management of Right Sided Aortic Arch Aneurysms. Clin Surg. 2016; 1: 1091.