Hybrid repair of acute type B dissection with aberrant right subclavian artery and bicarotid trunk

Patients with type B aortic dissection (TBAD) often present as an emergency. Operative repair of TBAD can be indi-cated for selected patients in the setting of hemodynamic instability or rupture. Thoracic endovascular aortic repair of TBAD has achieved significant popularity. Variant aortic arch anatomy can present a significant clinical challenge in patients with an inadequate proximal landing zone for thoracic endovascular aortic repair. A three-stage, hybrid aortic arch debranching and endovascular repair of a ruptured TBAD in a patient with a bicarotid trunk and an aberrant right subclavian artery was successfully performed using a unique technical approach. (J Vasc Surg Cases Innov Tech 2022;8:214-7.)