[Transposition of the Left Subclavian Artery Before a Thoracic Endovascular Aortic Repair for Type B Aortic Dissection].

Abstract

We encountered a patient who had undergone a transposition procedure, which encompassed the performance of subclavian-common carotid arterial end-to-side anastomosis before a thoracic endovascular aortic repair (TEVAR) when carrying out Stanford type B aortic dissection. A 50-year-old man was admitted to our hospital with a diagnosis of chronic Stanford type B aortic dissection that tended to expand. Transposition was performed in advance of zone 2 TEVAR. Lymphorrhea was observed under the skin following surgery. A decreasing tendency for lymphorrhea was confirmed at six months following the operation. Coil embolization was performed after the occurrence of a type I leak following TEVAR;the leak was repaired successfully during the procedure. No ischemic symptoms in the upper left limb or any cerebral complications were observed, demonstrating the safety of the transposition method. The transposition method can be the first choice for revascularization of the left subclavian artery because it requires only one incision, no anticoagulant drugs, and is expected to maintain patency for a long period.