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A 67-year-old male presented with abrupt onset of chest and back pain to an outside hospital. He was hypertensive with a serum creatinine of 4.4 g/dL and reported occasional cocaine use. Comorbidities include chronic renal insufficiency (baseline serum creatinine 1.8 g/dL), morbid obesity [body mass index (BMI) of 38], history of atrial fibrillation, and status post permanent pacemaker. Computed tomography (CT) demonstrated DeBakey type 1 dissection. The referral was received, and the Cleveland Clinic Acute Aortic Syndrome team was activated. The emergency medical transport team delivered the patient to our main campus where anti-impulse therapy was optimized in the cardiovascular triage intensive care unit and CT images were reviewed. CT demonstrated an extensive aortic dissection with poor visualization of the entry tear and a maximum descending aortic diameter of 40 mm just beyond the left subclavian artery. Also of interest, this patient had an anomalous left vertebral artery originating directly from the aortic arch distal to the origin of the left subclavian artery. He was taken to the hybrid operating room for emergency ascending and modified simplified branched frozen elephant trunk repair.

Frozen elephant trunk for DeBakey type 1 dissection: the Cleveland Clinic technique