迷走右锁骨下动脉合并主动脉夹层1例

迷走右锁骨下动脉（ARSA）是发自降主动脉近端较常见的主动脉弓大血管异常。ARSA在起始部位可出现内膜撕裂而导致主动脉夹层的发生，从而引起血流受限和后期的动脉瘤样变性。笔者报道了1例起源于ARSA的急性A型主动脉夹层。ARSA合并A型主动脉夹层实属罕见，术前经CT血管造影（CTA）得以确诊，CTA对本病进行外科治疗决策非常有价值。临床医师应对迷走右锁骨下动脉合并主动脉夹层引起注意，以做到早期诊断，早期处理。

Aortic dissection in presence of an aberrant right subclavian artery: a case report

The presence of an aberrant right subclavian artery (ARSA) arising from the proximal descending aorta is a relatively common anomaly of the aortic arch. These vessels may be involved in aortic dissections, either as the site of the primary intimal tear or as a dissected aortic branch, subject to flow limitation and future aneurysmal degeneration. We report a case involving a ruptured acute type A aortic dissection originating from ARSA. The coincidence of an ARSA with a complicated acute type A aortic dissection is extremely rare, as in the present case. This case was diagnosed preoperatively by computed tomography angiography (CTA), which is of great value for precise planning of surgical strategy in such cases. The aim of the case report is to make the clinicians aware of ARSA probably being accompanied with aortic dissection, so as to diagnose it and manage it rapidly and appropriately.