Carotid endarterectomy combined with vertebral artery transposition treating vertebral artery V1 segment stenosis combined with ipsilateral carotid artery stenosis / 中国胸心血管外科临床杂志

@#Objective    To explore the treatment outcome of carotid endarterectomy combined with vertebral artery transposition in patients with severe stenosis to occlusion of the vertebral artery V1 segment and the ipsilateral carotid artery. Methods    From June 2017 to September 2020, patients with severe stenosis to occlusion of the vertebral artery V1 segment and the ipsilateral carotid artery treated with carotid endarterectomy combined with vertebral artery transposition in Fuwai Hospital were retrospectively analyzed. Results    Finally 12 patients were enrolled, including 10 males and 2 females with an average age of 67.8±6.0 years. Twelve patients were successfully operated and the follow-up time was 1-3 years. The stenosis degree of the V1 segment of the vertebral artery decreased from 83.5%±11.8% to 24.9%±14.3% (P<0.001). The stenosis degree of carotid artery decreased from 85.6%±11.0% to 0% (P<0.001). Postoperative follow-up showed that the symptoms of symptomatic patients before surgery improved. The 1-year and 3-year patency rates were 100.0%, and there were no peripheral nerve injury complications, perioperative deaths or strokes. Conclusion    Carotid endarterectomy combined with vertebral artery transposition can treat ipsilateral carotid artery  stenosis and vertebral artery stenosis at the same time, improve blood supply to the brain, improve patients' symptoms and has high promotion value.

Debranching TEVAR with Left Vertebral Artery Transposition for Aortic Arch Aneurysm with Metal Allergy / 日本心臓血管外科学会雑誌

A 85-year-old man with an abnormal shadow on X-ray was given a diagnosis of aortic arch aneurysm by CT scan. Preoperative additional careful examinations revealed that his dominant vertebral artery was the left one and he had an allergy to metals such as platinum, tin and zinc. He underwent thoracic endovascular aortic repair (TEVAR) after revascularization of left vertebral artery by bypass grafting between bilateral axillary arteries and the left common carotid artery with a T-shape graft. Because of the position of the origin of the left vertebral artery from the left subclavian artery was comparatively proximal part, we made it transposition more distally to occlude the LSA by ligation. We selected conformable GORE® TAG® for zone-1 TEVAR because the stent graft, which was not composed of allergic metals, contained only less allergic metals than any other devices commercially available. More than two years have passed since his discharge and he was followed as an outpatient without any allergic symptom and other remarkable complications. Here, we report a rare case of 2 debranching TEVAR for aortic arch aneurysm with metal allergy.