ABSTRACT
Thoracic endovascular aortic repair (TEVAR) is valuable in the treatment of type B aortic dissection. An isolated left vertebral artery (ILVA) is a common anomaly of the aortic arch. The ILVA is covered during TEVAR in specific cases; however, whether the ILVA should be reconstructed in all cases remains controversial. We report a case of TEVAR performed for chronic aortic dissection in a patient with an ILVA. A 57-year-old woman with an ILVA had a type B acute aortic dissection one year prior to presentation and underwent TEVAR owing to dilation of an ulcer-like projection. We performed ILVA-left common carotid artery (LCCA) anastomosis and LCCA-left axillary artery bypass prior to TEVAR using our usual procedure. The postoperative course was favorable without any major complication. ILVA reconstruction may reduce the incidence of postoperative stroke and spinal cord injury. Usually, an ILVA is easily accessible through the supraclavicular approach, and the anatomical position of the vessel facilitates ILVA-LCCA anastomosis. ILVA reconstruction requires additional features and further consideration.
ABSTRACT
Spinal cord injury (SCI) is a main concern in patients who undergo thoracic endovascular therapy (TEVAR), because the blood flow of the vertebro-basilar artery may be reduced due to the left subclavian artery (LSA) occlusion. If the left vertebral artery originates directly from the aorta, which is called the isolated left vertebral artery (ILVA), a technical consideration for strategies regarding blood perfusion of the ILVA during TEVARs is required. We hereby aim to report three patients (No.1, No.2, and No.3) who underwent an ILVA translocation and TEVAR with Zone 2 landing for aortic dissection. The diameter of the ILVA was 4.2, 2.3, and 2.2 mm, respectively, and the right vertebral artery (RVA) was dominant in all cases. In Patient No.1 and No.2 (ILVA diameter: 4.2 and 2.3 mm, respectively), the ILVA was anastomosed directly to the left common carotid artery. In Patient No.2, the translocated ILVA was occluded resulting in SCI, but the SCI improved when blood pressure was augmented. In Patient No.3 (ILVA diameter: 2.2 mm), the saphenous vein graft was interposed between the ILVA and the bypass artery because the ILVA diameter was small, but postoperatively, the ILVA remained patent, and no paraplegia was observed. The occlusion of ILVA could cause SCI, even if the RVA is larger than the LVA. Reconstruction of the ILVA is a critical procedure to prevent postoperative SCIs in patients undergoing TEVARs.
ABSTRACT
Objeetive To summarize the resuhs of the surgical management of complicated type B dissection with an iso lated left vertebral artery(ILVA) using the stented elephant trunk technique.Methods Between February 2009 and September 2016,12 patients with complicated type B dissection(acute in 7 and chronic in 5) underwent the stented elephant trunk procedure under moderate circulatory arrest with selective antegrade cerebral perfusion.11 patients were males with a mean age of(50.9 ± 6.1) years(ranged 42-59 years).Preoperative limb ischaemia was obscrved in 2 patients,renal dysfunction in 1 patient.Results There was no in-hospital death.1 patient was suffered permanent hoarseness after the surgery.The cardiopulmonary bypass time was 143.1 ± 26.3 min and selective cerebral perfusion time was (27.2 ± 11.2) min.The follow-up time was 6-92 months,mean (40.9 ± 30.6) months.1 of the ischaemia of the limb patients was ameliorated after surgical stentgraft implantation,the other 1 was ameliorated after surgical stent-graft implantation combined with a bypass of the ascending aorta to the right femoral artery.No neurological deficits were observed in any patients prior to hospital discharge.2 patients underwent thoracic endovascular aortic repair and total thoracoabdominal aortic aneurysm repair respectively due to distal aortic aneurysm within the mean follow-up period.Conclusion Surgical repair of complicated type B dissection with an ILVA using the stented elephant trunk technique can obtain a satisfactory med-term clinical results.
ABSTRACT
Objeetive To summarize the resuhs of the surgical management of complicated type B dissection with an iso lated left vertebral artery(ILVA) using the stented elephant trunk technique.Methods Between February 2009 and September 2016,12 patients with complicated type B dissection(acute in 7 and chronic in 5) underwent the stented elephant trunk procedure under moderate circulatory arrest with selective antegrade cerebral perfusion.11 patients were males with a mean age of(50.9 ± 6.1) years(ranged 42-59 years).Preoperative limb ischaemia was obscrved in 2 patients,renal dysfunction in 1 patient.Results There was no in-hospital death.1 patient was suffered permanent hoarseness after the surgery.The cardiopulmonary bypass time was 143.1 ± 26.3 min and selective cerebral perfusion time was (27.2 ± 11.2) min.The follow-up time was 6-92 months,mean (40.9 ± 30.6) months.1 of the ischaemia of the limb patients was ameliorated after surgical stentgraft implantation,the other 1 was ameliorated after surgical stent-graft implantation combined with a bypass of the ascending aorta to the right femoral artery.No neurological deficits were observed in any patients prior to hospital discharge.2 patients underwent thoracic endovascular aortic repair and total thoracoabdominal aortic aneurysm repair respectively due to distal aortic aneurysm within the mean follow-up period.Conclusion Surgical repair of complicated type B dissection with an ILVA using the stented elephant trunk technique can obtain a satisfactory med-term clinical results.
ABSTRACT
The ascending aorta and aortic arch were replaced in a 72-year-old woman with Stanford type A aortic dissection. Preoperative three-dimensional computed tomography (3D-CT) revealed that the anatomy of an isolated left vertebral artery was abnormal. After hypothermic circulatory arrest, a 12-mm sealed graft was connected to the island-shaped arch under retrograde cerebral perfusion, followed by antegrade cerebral perfusion via a branch of the graft. The main graft was distally anastomosed, and the graft of the cerebral arteries was subsequently anastomosed on the main graft under continuous cerebral and systemic perfusion. The patient tolerated all procedures well without cerebral or bleeding complications, and was discharged 18 days after surgery. This technique was useful for island reconstruction, even with abnormal cerebral arteries and bleeding control of this anastomosis was simple compared to the conventional island technique.