RESUMEN
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.
RESUMEN
Se presenta una variación anatómica de la arteria vertebral izquierda, detectada en un cadáver utilizado para docencia en el Departamento de Anatomía de la Escuela de Medicina de la Pontificia Universidad Católica de Chile. En el mediastino superior del cadáver mencionado, se pudo apreciar que el arco aórtico da origen, de derecha a izquierda, a las siguientes ramas: arteria braquiocefálica, arteria carótida común izquierda, arteria vertebral izquierda aberrante y, finalmente, la arteria subclavia izquierda. La arteria vertebral izquierda aberrante se origina en la parte más alta del arco aórtico, presentando en este punto un diámetro de 4 mm; luego asciende a la izquierda de la carótida común ipsilateral y por sobre la cara anterolateral de la columna vertebral, tomando contacto con ramos cardíacos del tronco simpático cervical. Luego de un trayecto de 95 mm, ocupando el mediastino superior y la raíz del cuello, se hace profunda entrando en el foramen transverso de la 6 vértebra cervical, donde su calibre se ha reducido a 2,65 mm. En el presente trabajo, se discute la evolución que presentan las arterias intersegmentarias dorsales cervicales en la antímera izquierda que permite explicar esta variación anatómica.
An anatomical variation of the left vertebral artery, detected in a cadaver used for teaching purposes in the Department of Anatomy, School of Medicine, Catholic University of Chile is presented. In this case, the aortic arch gives rise, from right to left, to the following branches: the brachiocephalic artery, the left common carotid artery, the aberrant vertebral left artery and, finally, the left subclavian artery. The aberrant left vertebral artery originates from the top of the aortic arch, presenting here a diameter of 4 mm, then ascends to the left of the common carotid ipsilateral, over the anterolateral aspect of the spine, making contact with cardiac branches of the cervical sympathetic trunk. After ascending 95 mm, occupying the upper mediastinum and the root of the neck, the artery enters the transverse foramen of the 6th cervical vertebra, where its diameter was reduced to 2.65 mm. In this paper we discuss the development of the cervical dorsal intersegmental arteries in the left antimera, process that could explain this anatomical variation.