# Brachiocephalic Artery Dissection Following Type A Aortic Dissection Repair

## TL;DR

A rare case of brachiocephalic artery dissection following type A aortic dissection repair is presented, highlighting the risks and management strategies.

## Contribution

The paper reports a rare complication of brachiocephalic artery dissection caused by surgical clamping during ATAAD repair.

## Key findings

- Brachiocephalic artery dissection can occur as a residual issue after ATAAD repair.
- Endovascular stent grafting with a kissing technique successfully managed the dissection.
- Patient selection for intervention depends on overall health status.

## Abstract

Acute type A aortic dissection (ATAAD) is a life-threatening emergency that is associated with major morbidity and mortality. Arterial dissections, particularly the brachiocephalic artery, can remain as a residual dissection after type A aortic dissection repair. We present a rare case of brachiocephalic artery dissection due to the clamping effect and the management of ATAAD patients. A 47-year-old male known for aortic aneurysm and uncontrolled hypertension presented with high blood pressure, unequal pulses, and a history of chest pain. A thoracic and abdominal aorta angiogram showed aneurysmal dilatation of the aortic root and ascending aorta with a peripheral linear filling defect shortly distal to the aortic root. The patient underwent the Bentall procedure, hemi-arch replacement, and patent ductus arteriosus closure. The brachiocephalic artery was clamped. The angiogram showed right common carotid occlusion. Endovascular intervention was made by balloon-mounted covered stent graft and kissing technique. The patient had a smooth post-procedure period without major events. Iatrogenic brachiocephalic artery dissection can occur during type A aortic dissection repair and is frequently affected by residual dissection. The decision of intervention versus conservative management is based on a patient's general condition.