Total Arch Replacement and Frozen Elephant Trunk in Type A Dissection With Reconstruction of Aberrant Right Subclavian Artery

An aberrant right subclavian artery (ARSA) is encountered in approximately 0.5% to 2.0% of the general population and predisposes patients to aortic complications such as dissection secondary to vessel wall weakening. Acute Stanford type A aortic dissection with ARSA is extremely rare, and its deep location, complex arch branch repair, and frequent distal positioning of the primary entry render surgery highly challenging. Here we report a case of surgical treatment for acute type A aortic dissection with ARSA. Extraanatomic reconstruction of the ARSA was performed first, followed by total arch replacement with frozen elephant trunk, achieving effective cerebral protection and avoiding any manipulation of the deep aortic arch.